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Sample records for banded sleeve gastrectomy

  1. Simultaneous gastric band removal and sleeve gastrectomy: a comparison with front-line sleeve gastrectomy.

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    Rebibo, Lionel; Mensah, Emile; Verhaeghe, Pierre; Dhahri, Abdennaceur; Cosse, Cyril; Diouf, Momar; Regimbeau, Jean-Marc

    2012-09-01

    The placement of a gastric band (GB) prior to a sleeve gastrectomy (LSG) would increase postoperative complications, whether it is withdrawn or not at the time of the LSG. The purpose of this retrospective study was to evaluate and compare postoperative morbidity and outcome weight for simultaneous GB removal (RGB) and LSG (the RGB + LSG group) and front-line LSG only (the LSG group) after unsuccessful GB. From May 2005 to May 2009, 305 patients underwent first- or second-line LSG at Amiens University Hospital. The primary endpoint was the postoperative complication rate (according to the Clavien classification) in the RGB + LSG and LSG groups. The secondary endpoints were intra-operative data, postoperative data, and weight loss over a period of 2 years (body mass index, percentage of excess weight loss, and percentage of excess body mass index (BMI) loss). Univariate and multivariate propensity score analyses were used to search for independent risk factors for postoperative complications. The RGB + LSG group (n = 46) had a mean age of 42 and a mean BMI of 44 kg/m(2). The indication for surgery was renewed weight gain or insufficient weight loss in 68 % of these cases. The LSG group (n = 259) had a mean age of 41 and a mean BMI of 49.2 kg/m(2). All procedures were performed laparoscopically. The complication rate was 8.6 % in the RGB + LSG group and 8 % in the SG group (p = 0.42). The fistula rates in the two groups were 4.3 and 3.4 %, respectively (p = 0.56), and the mean BMI at 2 years was 33.4 kg/m(2) (RGB + LSG group) and 34.4 kg/m(2), respectively (p = 0.83). The operating time for LSG (after subtracting the time associated with RGB for a combined procedure) averaged 107 min, whereas the operating time for front-line LSG was 89 min (p = 0.011). The propensity score analysis failed to find independent risk factors for postoperative complications. The performance of RGB + LSG is feasible and does not increase the postoperative

  2. Laparoscopic Plicated Sleeve Gastrectomy: a Technical Report.

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    Ji, Yun; Ye, Huan; Wang, Yuedong; Zhan, Xiaoli; Zhu, Jinhui

    2016-01-01

    The standard approach to laparoscopic sleeve gastrectomy (LSG) involves sleeve-forming through a vertical gastrectomy, producing a narrow, tubular stomach. Considerable laparoscopic skills are required to find a suitable size at which the pressure of the sleeve is not excessive and the restriction is sufficient for obtaining good weight-loss effect without increasing the risk of complications. There is no doubt that considerable technical details are required to create a “perfect sleeve.” We report our sleeve-forming technique for LSG involving both vertical gastrectomy and plication, which we have termed “laparoscopic plicated sleeve gastrectomy.” This technique was shown to be safe and efficacious for the treatment of severe obesity and can reduce technical difficulties in the creation of a “perfect sleeve.”

  3. Weight Loss after Sleeve Gastrectomy in Super Superobesity

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    J.-M. Catheline

    2012-01-01

    Full Text Available Objective. This prospective study evaluated laparoscopic sleeve gastrectomy for its safety and efficiency in excess weight loss (%EWL in super superobese patients (BMI >60 Kg/m2. Results. Thirty patients (33 women and 7 men were included, with mean age of 35 years (range 18 to 59. Mean preoperative BMI was 66 Kg/m2 (range 60 to 85. The study included one patient with complete situs inversus and 4 (14% with previous restrictive gastric banding. The mean operative time was 120 minutes (range 80 to 220 min and the mean hospital stay was 7.5 days (4 to 28 days. There was no postoperative mortality or need for a laparotomy conversion. Two subphrenic hematomas, one gastric fistula, and one pulmonary embolism, were the major complications. After 18 months 17 (77% had sufficient weight loss and six had insufficient results, leading to either re-sleeve gastrectomy (3, or gastric bypass (2. Three years after the initial laparoscopic sleeve gastrectomy, the mean EWL was 51% (range 21 to 82. Conclusion. The laparoscopic sleeve gastrectomy is a safe and efficient operating procedure for treating super superobesity. In the case of insufficient weight loss, a second-stage operation like resleeve gastrectomy or gastric bypass can be proposed.

  4. The influence of laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy on weight loss, plasma ghrelin, insulin, glucose and lipids

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    Hady Razak Hady

    2012-07-01

    Full Text Available The aim of this study was to assess the impact of laparoscopic gastric banding and laparoscopic sleeve gastrectomy on the concentration of ghrelin, insulin, glucose, triglycerides, total and HDL-cholesterol, as well as AST and ALT levels in plasma in patients with obesity. The research includes 200 patients operated using LAGB (34 men average age 37.0 ± 12.6 years and 66 women average age 39.18 ± 12.17 years and LSG (48 men average age 47.93 ± 9.24 years and 52 women, 19 ± 9.33 years. The percentage of effective weight loss, effective BMI loss, concentration of ghrelin, insulin, glucose, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, ALT, AST and HOMA IR values was taken preoperatively and at 7th day, 1 month, 3 and 6 months after surgery. Both after LSG and after LAGB, statistically significant reduction in BMI, serum insulin, glucose and HOMA IR was noticed in comparison to the preoperative values. Post LAGB, patients showed an increase of ghrelin, while LSG proved ghrelin decreased. Correlations between glucose and BMI loss, and between insulin and BMI loss in both cases are more favorable in the LSG group. Lipid parameters, AST and ALT have undergone declines or  increases in the particular time points. Both techniques cause weight loss and this way lead to changes in the concentration of ghrelin, as well as to the improvement of insulin, glucose, cholesterol and triglycerides metabolism. They reduce metabolic syndrome and multiple comorbidities of obesity.

  5. Laparoscopic sleeve gastrectomy for morbid obesity

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    The incidence of obesity is steadily rising,and it has been estimated that 40% of the US population will be obese by the year 2025 if the current trend continues.In recent years there has been renewed interest in the surgical treatment of morbid obesity in concomitance with the epidemic of obesity.Bariatric surgery proved effective in providing weight loss of large magnitude,correction of comorbidities and excellent short-term and long-term outcomes,decreasing overall mortality and providing a marked survival advantage.The Laparoscopic Sleeve Gastrectomy (LSG) has increased in popularity and is currently very "trendy" among laparoscopic surgeons involved in bariatric surgery.As LSG proved to be effective in achieving considerable weight loss in the shortterm,it has been proposed by some as a sole bariatric procedure.This editorial focuses on the particular advantages of LSG in the treatment of morbid obesity.

  6. Safety Evaluation of Laparoscopic Sleeve Gastrectomy Compared with Two Procedures of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Adjustable Gastric Banding for Individuals with Morbid Obesity: A Systemic Review

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    F Arabi Basharic

    2015-10-01

    Full Text Available Introduction: Laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are the most common bariatric surgery procedures. Therefore, this study aims to compare the safety of the newer procedure of Laparoscopic sleeve gastrectomy compared to Laparoscopic Roux-en-Y gastric bypass and Laparoscopic adjustable gastric bonding. Method: A systematic review was conducted on the most important and most relevant search data bases, including Cochrane library, Pubmed, Ovid Medline as well as Iranian sites of Magiran , Iranmedex , SID, not taking the time limit into consideration. The results found in the literature were classified and were then analyzed. Results: Out of 384 articles obtained in the search, 4 randomized clinical trials (RCT were included in this study. There were no reports of death comparing surgical procedures of Roux-en-Y gastric bypass and sleeve gastrectomy. Moreover, in adjustable gastric banding and Roux-en-Y gastric bypass comparison, one death was observed in each group. Regarding the side effects of Roux-en-Y gastric bypass and sleeve gastrectomy, 10% early complications were reported in the Roux-en-Y gastric  bypass group , and 13% were observed in the sleeve gastrectomy group between which no statistically significant difference was revealed. The comparison between adjustable gastric banding and Roux-en-Y gastric bypass demonstrated that the occurrence of early and late complications was reported to be higher in the gastric bypass group, though no statistically significant difference was observed. Conclusion: The present study findings demonstrated no statistically significant difference between these methods in regard with the safety aspect. As a result, selection as well as success of the bariatric surgery procedures depend on the patient's and surgeon's preferences.

  7. Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy vs. Gastric Banding: The First Multicenter Retrospective Comparative Cohort Study in Obese Korean Patients

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    Lee, Sang Kuon; Park, Joong-Min; Kim, Yong-Jin; Kim, Seong-Min; Park, Do-Joong; Han, Sang-Moon; Shim, Kyung Won; Lee, Yeon-Ji; Kwon, Jin-Won

    2016-01-01

    Purpose Bariatric surgery is relatively new in Korea, and studies comparing different bariatric procedures in Koreans are lacking. This study aimed to compare the clinical outcomes of laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) for treating morbidly obese Korean adults. Materials and Methods In this multicenter retrospective cohort study, we reviewed the medical records of 261 obese patients who underwent different bariatric procedures. Clinical outcomes were measured in terms of weight loss and resolution of comorbidities, such as diabetes, hypertension, and dyslipidemia. Safety profiles for the procedures were also evaluated. Results In terms of weight loss, the three procedures showed similar results at 18 months (weight loss in 52.1% for SG, 61.0% for LAGB, and 69.2% for RYGB). Remission of diabetes, hypertension, and dyslipidemia was more frequent in patients who underwent RYGB (65.9%, 63.6%, and 100% of patients, respectively). Safety profiles were similar among groups. Early complications occurred in 26 patients (9.9%) and late complications in 32 (12.3%). In the LAGB group, five bands (6.9%) were removed. Among all patients, one death (1/261=0.38%) occurred in the RYGB group due to aspiration pneumonia. Conclusion The three bariatric procedures were comparable in regards to weight-loss outcomes; nevertheless, RYGB showed a higher rate of comorbidity resolution. Bariatric surgery is effective and relatively safe; however, due to complications, some bands had to be removed in the LAGB group and a relatively high rate of reoperations was observed in the RYGB group. PMID:27189291

  8. Complicated course after sleeve gastrectomy for obesity.

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    Zonca, P; Cambal, M; Jacobi, C A

    2010-01-01

    The authors present a case of a 52-year old female patient with sleeve gastrectomy for obesity. Two major complications occured after the surgery. The first one was a leakage on the third day after the surgery. The routine swallow examination on the first day after the surgery was normal. The pathological secretion from the drainage occurred on the third day after the surgery with a simultaneous increase in inflammatory markers. There were no clinical signs of sepsis. An indication for laparoscopic revision was done and a small defect in the staple line was identified. The oversewing of the small defect on the stomach was performed. Immediately after the second surgery the patient was clinicaly without any problems. The inflammatory markers decreased promptly after the surgery. The second complication was presented with decompensated psychosis, which developed on the 4th day after the second surgery. The patient complained of problems with swallowing despite the fact that the swallow contrast examination was normal. The patient received her psychiatric medication intravenously. The problem with swallowing was not based on any organic reason, and lasted for 4 weeks. During this period the patient was fed only parenterally. Almost 6 weeks after the surgery the patient became compensated and was dismissed. We would like to point out to the problems potentially occuring in patients with a psychiatric disease. Good compensation and stabilization of psychiatric disease is a condition that has to be met before a surgery (Tab. 1, Fig. 1, Ref. 21).

  9. Morbid obesity and sleeve gastrectomy: how does it work?

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    Papailiou, Joanna; Albanopoulos, Konstantinos; Toutouzas, Konstantinos G; Tsigris, Christos; Nikiteas, Nikolaos; Zografos, George

    2010-10-01

    Laparoscopic sleeve gastrectomy is known to be a safe and effective procedure for treating morbid obesity and is performed with increasing frequency both in Europe and the USA. Despite its broad use, many questions about the remaining gastric tube diameter, its long-term efficacy, its effects on gastric emptying, and the hormones involved still remain to be answered. In order to use such a relatively new surgical procedure wisely, it is essential for every surgeon and physician to understand how sleeve gastrectomy acts in obesity and what its potential benefits on the patients' metabolism are. This review focuses on the most important pathophysiologic questions referred to sleeve gastrectomy on the literature so far, in an attempt to evaluate the different issues still pending on the subject.

  10. Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity.

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    Acholonu, Emeka; McBean, Etwar; Court, Ismael; Bellorin, Omar; Szomstein, Samuel; Rosenthal, Raul J

    2009-12-01

    Laparoscopic sleeve gastrectomy (LSG) has been used as a first step of a two-stage approach in bariatric surgery for high-risk patients. Recently, LSG is being utilized as a primary and final procedure for morbid obesity with acceptable short-term results. The aim of this study is to investigate the effectiveness of LSG as a revisional procedure for patients with unsatisfactory outcomes after laparoscopic adjustable gastric band (LAGB). A retrospective review of a prospectively maintained database was performed. Data were reviewed for all patients undergoing revision from LAGB to LSG during the period May 2005 and May 2009. Data collected included demographics, indication for revision, operative time, length of stay, postoperative complications, and degree of weight reduction. Fifteen patients (three males and 12 females) had revisional surgery converting a LAGB to a LSG. The indication in four patients (26.66%) was weight regains and in five patients (33.33%) was poor weight loss; four patients (26.66%) had a band slippage and symptoms of gastroesophageal reflux, and one patient (6.66%) had poor weight loss, band slippage, and reflux. In one patient (6.66%), the indication was slippage and duodenal fistula. One-step revision procedure was done in 13 patients (86.66%), while two-step procedure was done in two patients (13.33%). Mean preoperative weight and BMI were 233.02 (181.4-300) lb and 38.66 (29.7-49.3) kg/m2, respectively. Mean weight loss at 2, 6, 12, 18, and 24 months postoperatively was 20.7, 48.3, 57.2, 60.1, and 13.5 lb, respectively. Mean % excess BMI loss was 28.9%, 64.2%, 65.3%, 65.7%, and 22.25% at 2, 6, 12, 18, and 24 months, respectively. There was one major complication (staple line leak) and one postoperative acute gastric outlet obstruction. We had no mortality. Thirteen patients were followed up postoperatively. The number decreased as follow-up time progressed. LSG could provide short-term weight loss after previously failed LABG, but prone to

  11. Comparative effectiveness and safety of gastric bypass, sleeve gastrectomy and adjustable gastric banding in a population-based bariatric program: prospective cohort study

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    Gill, Richdeep S.; Majumdar, Sumit R.; Rueda-Clausen, Christian F.; Apte, Sameer; Birch, Daniel W.; Karmali, Shahzeer; Sharma, Arya M.; Klarenbach, Scott; Padwal, Raj S.

    2016-01-01

    Background Bariatric surgery in Canada is primarily delivered within publicly funded specialty clinics. Previous studies have demonstrated that bariatric surgery is superior to intensive medical management for reduction of weight and obesity-related comorbidities. Our objective was to compare the effectiveness and safety of laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (LSG) and adjustable gastric banding (LAGB) in a publicly funded, population-based bariatric treatment program. Methods We followed consecutive bariatric surgery patients for 2 years. The primary outcome was weight change (in kilograms). Between-group changes were analyzed using multivariable regression. Last-observation-carried-forward imputation was used for missing data. Results We included 150 consecutive patients (51 RYGB; 51 LSG; 48 LAGB) in our study. At baseline, mean age was 43.5 ± 9.5 years, 87.3% of patients were women, and preoperative body mass index (BMI) was 46.2 ± 7.4. Absolute and relative (% of baseline) weight loss at 2 years were 36.6 ± 19.5 kg (26.1 ± 12.2%) for RYGB, 21.4 ± 16.0 kg (16.4 ± 11.6%) for LSG and 7.0 ± 9.7 kg (5.8 ± 7.9%) for LAGB (p < 0.001). Change in BMI was greater for the RYGB (−13.0 ± 6.6) than both the LSG (−7.6 ± 5.7) and the LAGB (−2.6 ± 3.5) groups (p < 0.001). The reduction in diabetes, hypertension and dyslipidemia was greater after RYGB than after LAGB (all p < 0.05). There were no deaths. The anastomotic and staple leakage rate was 1.3%. Conclusion In a publicly funded, population-based bariatric surgery program, RYGB and LSG demonstrated greater weight loss than the LAGB procedure. Bypass resulted in the greatest reduction in obesity-related comorbidities. All procedures were safe. PMID:27240132

  12. Repeat sleeve gastrectomy compared with primary sleeve gastrectomy: a single-center, matched case study.

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    Rebibo, Lionel; Fuks, David; Verhaeghe, Pierre; Deguines, Jean-Baptiste; Dhahri, Abdennaceur; Regimbeau, Jean-Marc

    2012-12-01

    Longitudinal sleeve gastrectomy (LSG) has been validated for the treatment of morbid obesity. However, treatment failures can appear several months after SG. Additional malabsorptive surgery is generally recommended in such cases. The objective of the present study was to evaluate the outcomes of repeat SG (re-SG) relative to first-line SG. This was a retrospective study included 15 patients underwent re-SG after failure of first-line SG (i.e. University Hospital, France; Public Practice). These patients were matched (for age, gender, body mass index and comorbidities) 1:2 with 30 patients having undergone first-line SG. The efficacy criteria comprised intra-operative data and postoperative data. The overall study population comprised 45 patients. The re-SG and first-line SG groups did not differ significantly in terms of median age (p = NS). The median BMI was similar in the two groups (43 kg/m(2) vs. 42.3 kg/m(2), p = NS). The two groups were similar in terms of the prevalence of comorbidities. The mean operating time was longer in the re-SG group (116 vs. 86 min; p ≤ 0.01). The postoperative complication rate was twice as high in the re-SG group (p = 0.31). Two patients in the re-SG group developed a gastric fistula (p = 0.25) and one of the latter died. At 12 months, the Excess Weight Loss was 66% (re-SG group) and 77% (first-line SG group) (p = 0.05). Re-SG is feasible but appears to be associated with a greater risk of complications. Nevertheless, re-SG can produce results (in terms of weight loss), equivalent to those obtained after first-line SG.

  13. Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy

    OpenAIRE

    2015-01-01

    Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal ...

  14. [Sleeve gastrectomy--technique, safety, success, trends].

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    Djalali, Peter; Birk, Dieter

    2009-01-01

    Despite the lack of sufficient data concerning the long-time results,the morbidity, and the mortality of laparoscopic sleeve resection, this operation is performed with growing enthusiasm.However, general principles of laparoscopic surgery need to be observed to ensure good results. This article describes an operative technique and indication for the operation.Attention must be turned on the complete liberation of the dorsal aspect of the stomach, the absence of crossing staple lines, and the competent handling of intraoperative leakages.The use of a 32 Fr bougie results in a residual stomach volume of about 80-100 ml. Due to a good operative technique and a competent follow-up, excess weight loss (EWL)of about 60% can be achieved within the first postoperative year.

  15. Esophageal adenocarcinoma five years after laparoscopic sleeve gastrectomy. A case report

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    Fernando Gabriel Wright

    2017-01-01

    Conclusion: We present a case of an esophageal adenocarcinoma five years after a laparoscopic sleeve gastrectomy for morbid obesity. There is need to better determine the relationship between sleeve gastrectomy and gastroesophageal reflux disease in order to prevent its related complications, such as esophageal adenocarcinoma.

  16. Concurrent laparoscopic morgagni hernia repair and sleeve gastrectomy.

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    Chiou, Grace; Tedesco, Maureen; Eisenberg, Dan

    2012-12-01

    The Morgagni-type anterior diaphragmatic hernia is a congenital defect that is a very uncommon hernia presenting in an adult. Surgical repair is usually recommended upon diagnosis and often requires synthetic mesh for a durable, tension-free repair. The use of synthetic mesh concurrently with several of bariatric operations is controversial owing to the potential for mesh infection. In this report we describe a laparoscopic repair of a symptomatic Morgagni hernia with synthetic mesh, concurrently with sleeve gastrectomy, in a morbidly obese man. The patient was a 58-year-old man with a body mass index of 48 kg/m(2) and associated co-morbid conditions that included obstructive sleep apnea, hypertension, hyperlipidemia, impaired fasting glucose, and osteoarthritis. He was diagnosed with Morgagni hernia with exertional dyspnia. He underwent concurrent laparoscopic Morgagni hernia repair with mesh and sleeve gastrectomy. At 2 months after surgery the patient was doing well and tolerating solid foods, and his percentage excess weight loss was 35%. He was exercising regularly and had no exertional dyspnea. Laparoscopy is an attractive approach to performing multiple intra-abdominal procedures concurrently. The Morgagni hernia repair with mesh can be performed safely and effectively using a laparoscopic approach. This can be performed concurrently with bariatric surgery in the morbidly obese.

  17. Wernicke’s encephalopathy after sleeve gastrectomy: Literature review

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    Pardo-Aranda, Fernando; Perez-Romero, Noelia; Osorio, Javier; Rodriguez-Santiago, Joaquín; Muñoz, Emilio; Puértolas, Noelia; Veloso, Enrique

    2016-01-01

    Objective To describe a case of Wernicke’s encephalopathy after laparoscopic sleeve gastrectomy. Setting Emergency Department and gastrointestinal surgery department. Case report A 20-year-old man class III obesity (BMI 50.17 kg/m2) underwent laparoscopic sleeve gastrectomy with uneventful recovery. Five weeks after surgery he was admitted in the Emergency Department because of persistent vomiting and dysphagia to solids. Esophagogastroduodenal transit and upper gastrointestinal endoscopy were requested but no relevant findings were shown. Laboratory analyses showed vitamin B1 12.2 ng/mL and 48 h following admission the patient experienced generalized weakness, sialorrhea and restrictions of actions such as reading a book. Neurological evaluation found confusion, motor ataxia, diplopy and nystagmus. A brain magnetic resonance was normal. According to low level of vitamin B1 and symptoms found in the patient a presumed diagnosis of Wernicke encephalopathy was made and parenteral thiamine 100 mg/day was started. The patient was discharged asymptomatic with oral intake of vitamin B1 600 mg per day. Conclusion Nutritional deficiencies after restrictive procedures are uncommon but easily preventable and can result in life threatening. With the upswing of bariatric surgery, surgeons and emergency physicians should be able to diagnose and treat those complications. Prophylactic thiamine should be administered to patients with predisposing factors. PMID:26826934

  18. De novo gastric adenocarcinoma 1 year after sleeve gastrectomy in a transplant patient

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    M. Masrur

    2016-01-01

    Conclusions: No direct relation has been established between sleeve gastrectomy and the development of gastric cancer. Robotic procedures allow for complex multiorgan resections, while preserving the benefits of minimally invasive surgery.

  19. A gastroplastia em manga (sleeve gastrectomy e o diabetes mellitus Sleeve gastrectomy and diabetes mellitus

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    Alexandre Ciro Andriani

    2008-09-01

    Full Text Available RACIONAL: O tipo 2 da diabete mellitus é muito frequente entre os pacientes de obesidade morbida. Ja foi provado cientificamente que o bypass gástrico pode curá-lo. Existem poucos relatos de que a gastroplastia em manga apresenta resultado promissores na cura desta forma de diabete. OBJETIVO: Apresentar resultados da glicemia em pacientes operados com a gastroplastia em manga mostrando sua possibilidade de controlar o dibetes. MÉTODO: Um estudo prospectivo envolvendo 15 pacientes foi realizado nos quais as dosagens sericas da glicose foram medidas no pré e pós-operatório. Para que houvesse homogeneidade da amostra, critérios de inclusão e exclusão foram estabelecidos com base nos pacientes com IMC de 35 a 40. Todos os pacientes foram submetidos a técnica cirurgica de gastroplastia em manga. O seguimento se deu em atendimento ambulatorial. RESULTADOS: Todos os pacientes foram operados pela técnica referida e seus níveis glicêmicos computados no pré, pós-operatório e no seguimento. CONCLUSÃO: A gastroplastia em manga cura o diabetes mellitus mostrando queda logo após a operação e mantendo-a ao longo do seguimento.BACKGROUND: The type 2 diabetes mellitus is very frequent among morbid obese patients. It has already been proven that the gastric bypass surgery may cures diabetes mellitus. There are few related studies to sleeve gastroplasty and diabetes. However, promising results exist. AIM: To analyse the glicemic results in patients submmitted to sleeve gastroplasty. METHODS: A 11 months prospective study on 15 patients was dome measuring their glycemic levels pre and postoperatively. The basic inclusion criteria was body mass index (BMI between 35 and 40 kg/m². All patients were operated by sleeve gastroplasty. RESULTS: All 15 patients lowered their glycemic level on their imidiate postoperative period and some achieved normal levels. CONCLUSIONS: The sleeve gastroplasty cures diabetes by lowering the plasma glucose and have

  20. Complications, Reoperations, and Nutrient Deficiencies Two Years after Sleeve Gastrectomy

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    Nicole Pech

    2012-01-01

    Full Text Available Background. The aim of this study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a follow-up of two years. Methods. Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included operative time, complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results. From September 26, 2005 to May 28, 2009, 82 patients (female : male = 48 : 34 with a mean age of 43.3 years (range: 22–64 and a preoperative BMI of 52.5 kg/m² (range: 36.8–77.0 underwent SG. Major complications were observed in 9.8% of the patients, with 1 death. During follow up 51.2% of patients were supplemented with iron, 36.6% with zinc, 37.8% with calcium, 26.8% with vitamin D, 46.3% with vitamin B12 and 41.5% with folic acid. %EWL was 54.3, 65.3 and 62.6% after 6, 12 and 24 months. Conclusion. SG as a single step procedure is an effective bariatric intervention. Nutritional deficiencies after SG can be detected by routine nutritional screening. Our results show that Vitamin B12 supplementation should suggest routinely after SG.

  1. Robotic versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Systematic Review and Meta-analysis.

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    Magouliotis, Dimitrios E; Tasiopoulou, Vasiliki S; Sioka, Eleni; Zacharoulis, Dimitrios

    2017-01-01

    We aim to review the available literature on obese patients treated with robotic or laparoscopic sleeve gastrectomy, in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane Library and EBSCOhost databases, in accordance with the PRISMA guidelines. Sixteen studies met the inclusion criteria incorporating 29,787 patients. Robotic sleeve gastrectomy (RSG) technique showed significantly higher mean operative time and increased length of hospital stay. Post-operative incidence of leakage, wound infection and bleeding, along with weight reduction, were comparable. The majority of the studies assessing charges found increased cost in RSG population. Well-designed, randomized controlled studies, comparing RSG to laparoscopic sleeve gastrectomy (LSG), are necessary to assess further their clinical outcomes and cost-effectiveness.

  2. Complications and nutrient deficiencies two years after sleeve gastrectomy

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    Pech Nicole

    2012-07-01

    Full Text Available Abstract Background The aim of this systematic study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a median follow-up of two years. Methods Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results From September 26, 2005 to May 28, 2009, 100 patients (female: male = 59:41 with a mean age of 43.6 years (range: 22–64 and a preoperative BMI of 52.3 kg/² (range: 36–77 underwent SG. The mean operative time was 86.4 min (range: 35–275. Major complications were observed in 8.0 % of the patients. During the follow-up period, 25 patients (25.0 % underwent a second bariatric intervention (22 DS and 3 RYGBP. Out of the total 100 patients, 48 % were supplemented with iron, 33 % with zinc, 34 % with a combination of calcium carbonate and cholecalciferol, 24 % with vitamin D, 42 % with vitamin B12 and 40 % with folic acid. The patients who received only a SG (n = 75 had %EWL of 53.6, 65.8 and 62.6 % after 6, 12 and 24 months, respectively. Conclusions SG is a highly effective bariatric intervention for morbidly obese patients. Nutritional deficiencies resulting from the procedure can be detected by routine nutritional screening. Results of the study show that Vitamin B12 supplementation should suggested routinely.

  3. Management of Super-super Obese Patients: Comparison Between Mini (One Anastomosis) Gastric Bypass and Sleeve Gastrectomy.

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    Madhok, Brijesh; Mahawar, Kamal K; Boyle, Maureen; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-07-01

    Management of super-super obese patients poses a particular challenge for bariatric surgeons. Many staged algorithms exist for these patients. Essentially all of these involve a lower-risk procedure like sleeve gastrectomy first before a definitive second-stage procedure like gastric bypass or duodenal switch. This study compares our results with 19 mini (one anastomosis) gastric bypass and 56 sleeve gastrectomy in super-super obese patients. Sleeve gastrectomy patients were significantly older. There was no mortality or major complication in either group. There was no minor complication in mini (one anastomosis) gastric bypass group compared to two in the sleeve gastrectomy group. Mini (one anastomsosis) gastric bypass patients experienced significantly higher weight loss compared to sleeve gastrectomy patients at 6 months, 1 year, and 2 years after surgery.

  4. Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

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    Mani Habibi

    2016-07-01

    Full Text Available Gastric leakage postsurgery is the most feared complication of laparoscopic sleeve gastrectomy due to the difficulty of its management. While gastric leakagemanagement postsurgery is often performed using internal drainage catheters accompanied by self-expandable metal stents, endoscopic internal drainage by double pigtail catheter has recently become a recommended approach. Here we describe our treatment of a patient who experienced distal gastric leakage after undergoing laparoscopic sleeve gastrectomy using double pigtail catheter and our treatment recommendations based on the patient outcome.

  5. One stage laparoscopic left adrenalectomy and sleeve gastrectomy by direct supragastric approach☆

    Science.gov (United States)

    de Gordejuela, Amador G. Ruiz; Gebelli, Jordi Pujol; García, Núria Vilarrasa; Medayo, Lluis Secanella; Marín, Araceli Estepa; Badía, Anna Casajoana

    2013-01-01

    INTRODUCTION The advances in laparoscopic surgical technique and the greater experience of surgical teams have enabled the combination of different surgical techniques in a single procedure. This paper presents a case of a sleeve gastrectomy and a left adrenalectomy by laparoscopy for a morbidly obese patient with Cushing's syndrome. PRESENTATION OF CASE A 52 year-old male patient with a BMI of 53 kg/m2 was diagnosed as having Cushing's syndrome caused by a left adrenal tumor. Sleeve gastrectomy was performed according to the usual technique. The adrenalectomy was performed at the same time by a left supragastric approach. The evolution was favorable, with 52% of excess weight loss observed after six months. Plasma and urinary cortisol at the 3- and 6-month follow-ups were under normal range and the patient required glucocorticoid therapy, confirming the cure of Cushing's syndrome. DISCUSSION Teams with experience of advanced laparoscopic surgery can successfully combine complex procedures in one surgical period. The approach we used for the adrenalectomy proved itself to be feasible after the sleeve gastrectomy. CONCLUSION Both procedures can be safely done in experience teams. Sleeve gastrectomy facilitates the direct supragastric approach. PMID:24394858

  6. Clinical–radiologic evaluation of the complications of laparoscopic sleeve gastrectomy: Value of multidetector CT

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    Tamir A. Hassan

    2015-12-01

    Conclusions: As LSG is performed increasingly and frequently, it is essential for radiologists to recognize the normal postoperative anatomy and identify the complications of this procedure. CT is an important imaging tool to diagnose suspected complications of laparoscopic sleeve gastrectomy procedure to ensure accurate diagnosis.

  7. Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Gokulakkrishna; Subhas; Anupam; Gupta; Mubashir; Sabir; Vijay; K; Mittal

    2015-01-01

    Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on postoperative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement.

  8. Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy

    Science.gov (United States)

    Subhas, Gokulakkrishna; Gupta, Anupam; Sabir, Mubashir; Mittal, Vijay K

    2015-01-01

    Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on post-operative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement. PMID:26649158

  9. SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY AND HIV

    Science.gov (United States)

    PINTO, José Máximo Costa; de LIMA, Marianna Gomes Cavalcanti Leite; de ALMEIDA, Ana Luiza Melo Cavalcanti; SOUSA, Marcelo Gonçalves

    2016-01-01

    ABSTRACT Introduction: It is estimated that there are nearly 40 million people with the human immunodeficiency virus (HIV) worldwide. Due to the advent of antiretroviral drugs, it has been observed increasing in obesity and metabolic rates among patients undergoing treatment. Thus, numerous surgical therapies for weight loss are proposed for continuous improvement in health of patients with HIV, being the vertical gastrectomy an option for intact intestinal transit. Objective: To evaluate the applicability of the vertical gastrectomy in patients with morbid obesity and HIV. Methods: Was conducted a systematic review of the literature, in the electronic databases Scopus, Pubmed, Cinahl, Scielo, Cochrane and Lilacs, from 1998 to 2015. MeSH headings used in data collection were "Gastrectomy" and "Morbid obesity" being combined with the descriptor "HIV". Were found 2148 articles in Scopus, 1234 in PubMed and 784 in Cinahl. The articles were analyzed by the Jadad Quality Scale, being reduced to 40 articles, subsequently reassessed using an elaborated form by the Critical Appraisal Skills Programme (CASP), reaching 12 articles in the end. Conclusion: It was found that vertical gastrectomy constitutes a safe and effective method, with low mortality and low rate of postoperative complications, being recommended as surgical technique in patients with obesity, HIV and comorbidities. PMID:27683793

  10. Simple, Safe, and Cost-Effective Technique for Resected Stomach Extraction in Laparoscopic Sleeve Gastrectomy

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    Serhan Derici

    2016-01-01

    Full Text Available Background. Laparoscopic sleeve gastrectomy (LSG has become a popular operation during the recent years. This procedure requires resection of 80–90% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15 mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device.

  11. Endoscopic treatment of the fistulas after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

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    Luís Gustavo Santos Périssé

    2015-06-01

    Full Text Available OBJECTIVE: to evaluate the use of endoscopic self-expandable metallic prostheses in the treatment of fistulas from sleeve gastrectomy and Roux en y gastric bypass.METHODS: all patients were treated with fully coated auto-expandable metallic prostheses and were submitted to laparoscopic or CT-guided drainage, except for those with intracavitary drains. After 6-8 weeks the prosthesis was removed and if the fistula was still open a new prostheses were positioned and kept for the same period.RESULTS: the endoscopic treatment was successful in 25 (86.21% patients. The main complication was the migration of the prosthesis in seven patients. Other complications included prosthesis intolerance, gastrointestinal bleeding and adhesions. The treatment failed in four patients (13.7% one of which died (3.4%.CONCLUSION: endoscopic treatment with fully coated self-expandable prosthesis was effective in treating most patients with fistula after sleeve gastrectomy and roux en y gastric bypass.

  12. Portal Vein Thrombosis due to Prothrombin Gene Mutation following Sleeve Gastrectomy

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    Murad Baba

    2015-01-01

    Full Text Available Introduction. Portomesenteric thrombosis is increasingly recognized as a complication of laparoscopic sleeve gastrectomy (LSG. It often presents with abdominal pain. We present a mother and her son who both developed portal vein thrombosis (PVT after LSG. Case Description. A 43-year-old woman presented complaining of sudden severe abdominal pain, two weeks after she had uncomplicated laparoscopic sleeve gastrectomy. CT scan of the abdomen and pelvis with IV contrast showed portal vein thrombosis and SMV thrombosis. Two weeks later her son had the same LSG for morbid obesity and presented with the same clinical picture. Thrombophilia workup showed heterozygous prothrombin gene mutation. Conclusions. A high index of suspicion is necessary to diagnose PVT; although rare, it can be potentially lethal. Anticoagulation therapy should be initiated immediately to limit the morbidities and improve the outcome. Patients with family history of thrombophilia should be investigated prior to any bariatric surgery and nonsurgical alternative treatments for morbid obesity should be strongly encouraged.

  13. MEDIUM-TERM FOLLOW-UP RESULTS WITH LAPAROSCOPIC SLEEVE GASTRECTOMY

    Science.gov (United States)

    RAMOS, Almino Cardoso; BASTOS, Eduardo Lemos de Souza; RAMOS, Manoela Galvão; BERTIN, Nestor Tadashi Suguitani; GALVÃO, Thales Delmondes; de LUCENA, Raphael Torres Figueiredo; CAMPOS, Josemberg Marins

    2015-01-01

    Background : The indications for sleeve gastrectomy in the surgical treatment of morbid obesity have increased worldwide. Despite this, several aspects related to results at medium and long term remain in constant research. Aim : To present the experience of sleeve gastrectomy in a center of excellence in bariatric surgery by analyzing clinical outcomes, complications and follow-up in the medium term. Methods : The study included 120 morbidly obese patients who underwent sleeve gastrectomy and who were followed for at least 24 months. Aspects related to surgical technique, surgical complications and clinical outcome were analyzed. Results : Seventy-five patients were women (62.5%) and the average age was 36 years. The body mass index preoperatively ranged from 35.5 to 58 kg/m2(average of 40.2 kg/m2). The length of stay ranged from 1 to 4 days (mean 2.1 days). Comorbidities observed were hypertension (19%), type 2 diabetes mellitus (6.6%), dyslipidemia (7.5%), sleep apnea (16.6%), reflux esophagitis (10%) and orthopedic diseases (7.5%). The mean body mass index and total weight loss percentage with 3, 12, 18 and 24 months were 32.2 kg/m2-19,9%; 29.5 kg/m2-26,5%; 28.2 kg/m2-30,3% and 26.9 kg/m2-32,7%, respectively. Remission of diabetes and dyslipidemia occurred in all patients. In relation to hypertension, there was improvement or remission in 86%. There were only two complications (bronchial pneumonia and dehydration), with good response to clinical treatment. There was no evidence digestive fistula and mortality was zero. Eleven patients (9.1%) had regained weighing more than 5 kg. Conclusion : The sleeve gastrectomy is surgical technique that has proven safe and effective in the surgical treatment of obesity and control of their comorbidities in postoperative follow-up for two years. PMID:26537277

  14. Laparoscopic sleeve gastrectomy for a two-and half year old morbidly obese child ☆

    OpenAIRE

    Mohaidly, Mohammed Al; Suliman, Ahmed; Malawi, Horia

    2013-01-01

    INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is an accepted technique in bariatric surgery for reducing obesity. Recent reports indicate it to be effective even in children but it has not been tried in very young children. PRESENTATION OF CASE We report here a case of a 2 and half years old child subjected to LSG for his morbid obesity and associated obstructive sleep apnea and bowing of legs. LSG was performed after investigations ruled out hereditary or genetic causes of obesity. The ...

  15. Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy

    Science.gov (United States)

    Almadi, Majid A; Bamihriz, Fahad; Aljebreen, Abdulrahman M

    2013-01-01

    Bariatric surgeries have been used in an effort to curtail the obesity epidemic. The type of surgery used has changed over time, with sleeve gastrectomies being one of the preferred options. This has been associated with some complications, including staple line leaks. We report a 43-year old female who had undergone a laparoscopic sleeve gastrectomy that was complicated by a proximal gastric pouch leak at the gastroesophageal junction. We used self-expandable stents (SEMS) in the management of the leak. Seven weeks after the insertion of the initial SEMS, the patient presented with a massive gastrointestinal bleed that could not be localized due to profuse bleeding. The patient underwent a computerized tomography angiogram and then an angiogram that could not localize the site of the bleed. An emergency laparotomy was performed and identified the source of bleeding to be an aortoesophageal fistula. A graft of the diseased area was attempted but the patient unfortunately did not survive the procedure. An aortoesophageal fistula after an esophageal SEMS insertion for a benign disease has rarely been reported and only in cases where there was a thoracic neoplasm, thoracic aortic aneurism, endovascular stent repair, foreign body or esophageal surgery. To our knowledge, this is the first case that reports an aortoesophageal fistula as a result of a SEMS for the management of a gastric pouch leak after a laparoscopic sleeve gastrectomy. PMID:24392186

  16. Sleeve gastrectomy prevents lipoprotein receptor-1 expression in aortas of obese rats

    Institute of Scientific and Technical Information of China (English)

    Jie Bai; Yong Wang; Yuan Liu; Dong-Hua Geng; Jin-Gang Liu

    2011-01-01

    AIM: To investigate the effects of sleeve gastrectomy on adipose tissue infiltration and lectin-like oxidized low density lipoprotein receptor-1 (LOX-1) expression in rat aortas.METHODS: Twenty-four rats were randomized into three groups: normal chow (control), high fat diet (HD) and high fat diet with sleeve gastrectomy (SG). After surgery, the HD and SG groups were fed a high fat diet. Animals were sacrificed and plasma high density lipoprotein (HDL) and low density lipoprotein (LDL) lev-els were determined. LOX-1 protein and LOX-1 mRNA expression was also measured. Aortas were stained with Nile red to visualize adipose tissue.RESULT: Body weights were higher in the HD group compared to the other groups. HDL levels in control, HD, and SG groups were 32.9 ± 6.2 mg/dL, 43.4 ± 4.0 mg/dL and 37.5 ± 4.3 mg/dL, respectively. LDL levels in control, HD, and SG groups were 31.8 ± 4.5 mg/dL, 53.3 ± 5.1 mg/dL and 40.5 ± 3.7 mg/dL, respectively. LOX-1 protein and LOX-1 mRNA expression was greater in the HD group versus the other groups. Staining for adipose tissue in aortas was greater in the HD group in comparison to the other groups. Thus, a high fat diet elevates LOX-1 protein and mRNA expression in aorta. CONCLUSION: Sleeve gastrectomy decreases plasma LDL levels, and downregulates LOX-1 protein and mRNA expression.

  17. Potential Mechanisms Mediating Sustained Weight Loss Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Makaronidis, Janine M; Batterham, Rachel L

    2016-09-01

    Bariatric surgery is the only effective treatment for severe obesity. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the most commonly performed procedures, lead to sustained weight loss, improvements in obesity-related comorbidities and reduced mortality. In humans, the main driver for weight loss following RYGB and SG is reduced energy intake. Reduced appetite, changes in subjective taste and food preference, and altered neural response to food cues are thought to drive altered eating behavior. The biological mediators underlying these changes remain incompletely understood but changes in gut-derived signals, as a consequence of altered nutrient and/or biliary flow, are key candidates.

  18. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Liu, Shirley Yuk-Wah; Wong, Simon Kin-Hung; Ng, Enders Kwok-Wai

    2015-01-01

    The management of gastric leak after laparoscopic sleeve gastrectomy (LSG) can be complex and challenging. Whilst operative interventions are mostly complicated and reserved for unstable or refractory cases, endoscopic self-expandable metal stenting (SEMS) is increasingly preferred as a safer treatment option. Yet, SEMS carries the problems of frequent stent migration and inconsistent healing as ordinary SEMS is designed mainly for stenotic disease. We hereby present two cases of early and chronic post-LSG leakage that were respectively failed to be treated by surgery and ordinary SEMS but were successfully managed by a dedicated extra-long oesophago-gastro-duodenal stent. In oesophago-gastro-duodenal stenting, the characteristics of extra-long stent length allow total gastric exclusion between the mid-oesophagus and the first part of duodenum to prevent stent migration and to equalise high pressure gradient within the gastric sleeve to promote fistula healing.

  19. A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report

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    Erika Leung

    2015-09-01

    Full Text Available Background: Obesity is a growing problem all over the world, including the United States. Single-incision laparoscopic sleeve gastrectomy is a surgery performed for patients who want to lose weight. The number of deaths resulting from thromboembolic complications from bariatric surgeries continues to be of major concern. Case Description: A 38-year-old female was admitted for single incision sleeve gastrectomy and was discharged home three days later. Subsequently she began to have abdominal pain, nausea and vomiting. A CT scan revealed superior mesenteric vein thrombosis with small bowel ischemia, splenic infarction and main and right portal vein branch thrombosis. An exploratory laparotomy demonstrated necrotic bowel due to abdominal compartment syndrome, and an area of small bowel was resected due to internal hernia. Surgical management of the patient during her second hospital stay included a decompressive laparotomy, internal hernia reduction, a small bowel resection. Discussion: Superior mesenteric vein thrombosis can be a life-threatening complication and present with non-specific presentations; thus, it is imperative that it is identified and managed promptly as these cases carry significant morbidity and mortality. Obese patients who undergo bariatric surgery frequently have other co-morbidities; many of which can complicate a case further. Mesenteric vein thromboses are normally treated with unfractionated or low-molecular-weight heparin.

  20. Concurrent Mesh Repair of a Morgagni and Umbilical Hernia during a Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Individual

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    N.R Kosai

    2016-10-01

    Full Text Available Morgagni Hernia is a rare form of diaphragmatic hernia. It is mainly asymptomatic and often identified incidentally during surgery. Tension-free synthetic mesh repair is the preferred treatment modality. However, the use of synthetic mesh concurrently during a clean-contaminated surgery such as sleeve gastrectomy remains controversial due to the remote possibility of mesh infection. A middle-aged female 2 with BMI of 47 Kg/m was admitted electively for laparoscopic sleeve gastrectomy with concurrent umbilical hernia repair. Intra-operatively, a left Morgagni Hernia containing omentum and a segment of transverse colon was noted. She underwent a laparoscopic sleeve gastrectomy and simultaneous laparoscopic tension-free composite mesh repair of both Morgagni and umbilical hernia. Outpatient review three months later revealed excess weight loss of almost 30% with no recurrence of either hernia. In conclusion, the advantages of concurrent hernia repair during bariatric surgery outweigh the risk of mesh infection and should be performed to prevent future risk of visceral herniation and strangulation. Laparoscopic mesh repair of a Morgagni Hernia and umbilical hernia in the setting of an electively planned sleeve gastrectomy is feasible, effective and safe in the hands of a trained laparoscopic surgeon.

  1. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch

    NARCIS (Netherlands)

    Homan, J.; Betzel, B; Aarts, E.O.; Laarhoven, K.J. van; Janssen, I.M.C.; Berends, F.J.

    2015-01-01

    BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain and other complications are reported. Demand for secondary surgery is rising, partly for these reasons. OBJECTIVES

  2. The success of sleeve gastrectomy in the management of metabolic syndrome and obesity

    Institute of Scientific and Technical Information of China (English)

    Asim Shabbir; Dallan Dargan

    2015-01-01

    The rapid reversal of diabetes,hypertension,hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic syndrome.Sleeve gastrectomy,which developed initially as a preparatory procedure for biliopancreatic diversion with duodenal switch,has seen an exponential rise in popularity as an effective lone laparoscopic bariatric procedure.Superior excess weight loss,a low complication rate,and excellent food tolerance,combined with a short hospital stay,have made this the procedure of choice for patients and surgeons across the globe.High volume centres nurture the ongoing development of experienced and specialized teams,pathways and regimens.Optimum surgical outcomes allow minimization of metabolic syndrome,reducing cardiovascular and cerebrovascular risk.

  3. The Use of Serum Uric Acid Concentration as an Indicator of Laparoscopic Sleeve Gastrectomy Success

    Science.gov (United States)

    Menenakos, Evangelos; Doulami, Georgia; Tzanetakou, Irene P.; Natoudi, Maria; Kokoroskos, Nikolaos; Almpanopoulos, Konstantinos; Leandros, Emmanouil; Zografos, George; Theodorou, Dimitrios

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) effectively reduces weight by restricting gastric capacity and altering gut hormones levels. We designed a prospective study to investigate the correlation of serum uric acid (SUA) concentration and weight loss. SUA and body mass index (BMI) were measured preoperatively and on first postoperative month and year in patients who underwent LSG in our department of bariatric surgery. Data on 55 patients were analyzed. Preoperative SUA concentration had a significant positive correlation with percentage of total weight loss (TWL) on first postoperative month (P = 0.001) and year (P = 0.002). SUA concentration on first postoperative month had a positive correlation with percentage of TWL on first postoperative year (P = 0.004). SUA concentration could be used as a predictor of LSG's success and could help in early detection of patients with rapid loss of weight, in order to prevent complications. PMID:25594659

  4. A Fatal Case of Wernicke’s Encephalopathy after Sleeve Gastrectomy for Morbid Obesity

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    Dimitrios K. Manatakis

    2014-01-01

    Full Text Available Wernicke’s encephalopathy is an acute neuropsychiatric disorder, due to thiamine (vitamin B1 deficiency. It is traditionally described in chronic alcohol abusers; however obesity surgery is an emerging cause, as the number of bariatric procedures increases. A high index of clinical suspicion is required, since initial symptoms may be nonspecific and the classic triad of ophthalmoplegia, gait and stance disorders, and mental confusion is present only in one-third of patients. Laboratory tests can be within normal range and typical MRI brain lesions are found only in 50% of cases. Aggressive supplementation with intravenous thiamine should not be delayed until confirmation of diagnosis, as it may fully reverse symptoms, but almost half the patients will still display permanent neurological deficit. We present our experience with a fatal case of Wernicke’s encephalopathy, following laparoscopic sleeve gastrectomy for morbid obesity.

  5. Portomesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and a call for prevention

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    Parveen Bhatia

    2015-01-01

    Full Text Available Postoperative portomesenteric venous thrombosis (PMVT is being increasingly reported after bariatric surgery. It is variable and often a nonspecific presentation along with its potential for life-threatening and life-altering outcomes makes it imperative that it is prevented, detected early and treated optimally. We report the case of a 50-year-old morbidly obese man undergoing a laparoscopic sleeve gastrectomy who developed symptomatic PMVT two weeks postsurgery, which was successfully treated by anticoagulant therapy. We provide postulates to the etiopathological mechanism for this thrombotic entity. The growing recognition that obesity and bariatric surgery create a procoagulant state regionally and systemically provides impetus for designing the ideal protocol for PMVT prophylaxis, which could be more common than currently believed. We support the early screening for PMVT in the postbariatric surgical patient with unexplainable or intractable abdominal symptoms. The role of routine surveillance and the ideal duration of post-PMVT anticoagulation is yet to be elucidated.

  6. Mechanistic comparison between gastric bypass vs. duodenal switch with sleeve gastrectomy in rat models.

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    Yosuke Kodama

    Full Text Available BACKGROUND: Both gastric bypass (GB and duodenal switch with sleeve gastrectomy (DS have been widely used as bariatric surgeries, and DS appears to be superior to GB. The aim of this study was to better understand the mechanisms leading to body weight loss by comparing these two procedures in experimental models of rats. METHODS: Animals were subjected to GB, DS or laparotomy (controls, and monitored by an open-circuit indirect calorimeter composed of comprehensive laboratory animal monitoring system and adiabatic bomb calorimeter. RESULTS: Body weight loss was greater after DS than GB. Food intake was reduced after DS but not GB. Energy expenditure was increased after either GB or DS. Fecal energy content was increased after DS but not GB. CONCLUSION: GB induced body weight loss by increasing energy expenditure, whereas DS induced greater body weight loss by reducing food intake, increasing energy expenditure and causing malabsorption in rat models.

  7. Hair loss in females after sleeve gastrectomy: predictive value of serum zinc and iron levels.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Oller, Inmaculada; Llavero, Carolina; Zubiaga, Lorea; Diez, María; Arroyo, Antonio; Calero, Alicia; Calpena, Rafael

    2014-05-01

    A common complication after bariatric surgery is hair loss, which is related to rapid weight reduction, but zinc, iron, and other micronutrient deficiencies can also be involved. Little is studied after laparoscopic sleeve gastrectomy (LSG). A prospective observational study was performed of 42 morbidly obese females undergoing LSG. Incidence of hair loss was monitored. Micronutrients were investigated preoperatively and three, six, and 12 months after surgery. Sixteen patients (41%) reported hair loss in the postoperative course. A significant association was observed between hair loss and zinc levels (P = 0.021) but mean zinc levels were within the normal range in patients reporting hair loss. Only three patients (7.7%) presented low zinc levels, all of them reporting hair loss. There was also a significant association between iron levels and alopecia (P = 0.017), but mean values of the patients with hair loss were within normal range. Only four patients (10.2%) presented low iron levels, all of them presenting hair loss. A variable consisting of the addition of zinc + iron showed a significant association with hair loss (P = 0.013). A cutoff point was established in 115 (odds ratio, 4; P = 0.006). All the patients but two reporting hair loss presented addition levels under 115. This variable showed sensibility 88 per cent, specificity 84 per cent, positive predictive value 79 per cent, and negative predictive value 91 per cent to predict hair loss. Hair loss is a frequent condition after sleeve gastrectomy. In most cases, iron and zinc levels are within the normal range. The variable addition (zinc + iron) is a good predictor of hair loss. Patients with addition levels below 115 are fourfold more susceptible to present hair loss. In these cases, zinc supplements achieve the stop of hair loss in most cases.

  8. The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass

    Science.gov (United States)

    Arndtz, Katherine; Steed, Helen; Hodson, James; Manjunath, Srikantaiah

    2016-01-01

    Background This study aimed to assess the endoscopic burden of bariatric surgical procedures at our trust. This is an enhanced parallel study to “The Hidden Endoscopic burden of Roux-en-Y Gastric Bypass” published in Frontline Gastroenterology in 2013 incorporating the data for sleeve gastrectomy and comparison with Roux-en-Y gastric bypass (RYGB). Methods This is a retrospective study that included 211 patients undergoing sleeve gastrectomy over a 34-month period. We utilized previously collected data for the RYGB patient cohort which included 553 patients over a 29-month period. We searched our hospital endoscopic database for patients who underwent post-operative endoscopy for indications related to their surgery. Results 16.6% of the sleeve gastrectomy patients required post-operative endoscopy, of whom 11.4% underwent therapeutic procedures. This compares to 20.4% of the RYGB cohort of whom 50.4% needed therapeutic procedures (Psleeve gastrectomy patients encountered a post-operative staple line leak and collectively required 29 endoscopic procedures. One patient also developed stricturing (0.47%) requiring 18 pneumatic dilatations. 11.4% of the RYGB cohort developed an anastomotic stricture requiring 57 balloon dilatation procedures. To date, these procedures have accumulated an equivalent cost of €159,898 in endoscopy tariffs, or €177 per RYGB and €373 per sleeve gastrectomy performed. Conclusions Bariatric surgery can have significant implications in terms of patient morbidity and financial cost. Having a local bariatric surgery service increases the demand for endoscopic procedures in our hospital, both in investigating for and dealing with post-operative complications. Provision of extra resources and expertise needs to be taken into account. PMID:26752949

  9. One Year Follow-up Results after Sleeve Gastrectomy in Type 2 Diabetes Mellitus Patients with Morbid Obesity

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    Dejeu Viorel

    2016-06-01

    Full Text Available Background and aims: Bariatric surgery has been shown to be superior to nonsurgical approaches in terms of weight loss and remission of type 2 diabetes (T2DM and metabolic syndrome. This prospective, single-center, follow-up study assessed percentage of excessive weight loss (%EWL, glycosylated hemoglobin (HbA1c levels, prescribed antidiabetes drugs and diabetes remission rates in obese T2DM patients who underwent laparoscopic sleeve gastrectomy.

  10. Dry beriberi preceded Wernicke′s encephalopathy: Thiamine deficiency after laparoscopic sleeve gastrectomy

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    Debopam Samanta

    2015-01-01

    Full Text Available In recent times, pediatric obesity has become widely prevalent. If first-line treatment with lifestyle modification fails, bariatric surgery may be indicated for severely obese patients. Many patients now travel abroad to get these surgeries done. Some of these patients receive inadequate postoperative care. We described a morbidly obese 17-year-old girl who had a laparoscopic sleeve gastrectomy procedure for weight loss. Due to severe nausea, she stopped her multivitamin supplementation. Within a few weeks, she developed symptoms of dry beriberi was soon followed by classic symptoms of Wernicke′s encephalopathy. The prompt diagnosis was made with confirmation from serum thiamine level and brain magnetic resonance imaging. Thiamine supplementation reversed ophthalmological symptoms promptly. However, the patient needed inpatient rehabilitation for neuropathy. This case describes that thiamine deficiency can occur after restrictive bariatric surgery, despite lower risk of malnutrition in the absence of intestinal bypass procedure. This report highlights that in the presence of risk factors: dietary noncompliance, inadequate follow-up, and severe nausea with and without vomiting can precipitate the development of Wernicke′s encephalopathy, even after restrictive surgery. Physicians may increasingly encounter thiamine and other nutrient deficiencies in increasing numbers due to increasing prevalence of obesity disorders and availability of bariatric surgeries. This report also emphasized the importance of identifying vague sensory symptoms in thiamine deficiency.

  11. Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy

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    Mauro Montuori

    2017-01-01

    Full Text Available Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years’ experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%. All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6–34 days, SD ± 11.85. We recorded one death (16.67% due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26–83 days; SD ± 25.44. Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures.

  12. Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Alter the Gut-Brain Communication

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    L. A. Ballsmider

    2015-01-01

    Full Text Available This study investigated the anatomical integrity of vagal innervation of the gastrointestinal tract following vertical sleeve gastrectomy (VSG and Roux-en-Y gastric bypass (RYGB operations. The retrograde tracer fast blue (FB was injected into the stomach to label vagal neurons originating from nodose ganglion (NG and dorsal motor nucleus of the vagus (DMV. Microglia activation was determined by quantifying changes in the fluorescent staining of hindbrain sections against an ionizing calcium adapter binding molecule 1 (Iba1. Reorganization of vagal afferents in the hindbrain was studied by fluorescent staining against isolectin 4 (IB4. The density of Iba1- and IB4-immunoreactivity was analyzed using Nikon Elements software. There was no difference in the number of FB-labeled neurons located in NG and DMV between VSG and VSG-sham rats. RYGB, but not RYGB-sham rats, showed a dramatic reduction in number of FB-labeled neurons located in the NG and DMV. VSG increased, while the RYGB operation decreased, the density of vagal afferents in the nucleus tractus solitarius (NTS. The RYGB operation, but not the VSG procedure, significantly activated microglia in the NTS and DMV. Results of this study show that the RYGB, but not the VSG procedure, triggers microglia activation in vagal structures and remodels gut-brain communication.

  13. The Initial Learning Curve for Robot-Assisted Sleeve Gastrectomy: A Surgeon's Experience While Introducing the Robotic Technology in a Bariatric Surgery Department.

    Science.gov (United States)

    Vilallonga, Ramon; Fort, José Manuel; Gonzalez, Oscar; Caubet, Enric; Boleko, Angeles; Neff, Karl John; Armengol, Manel

    2012-01-01

    Objective. Robot-assisted sleeve gastrectomy has the potential to treat patients with obesity and its comorbidities. To evaluate the learning curve for this procedure before undergoing Roux en-Y gastric bypass is the objective of this paper. Materials and Methods. Robot-assisted sleeve gastrectomy was attempted in 32 consecutive patients. A survey was performed in order to identify performance variables during completion of the learning curve. Total operative time (OT), docking time (DT), complications, and length of hospital stay were compared among patients divided into two cohorts according to the surgical experience. Scattergrams and continuous curves were plotted to develop a robotic sleeve gastrectomy learning curve. Results. Overall OT time decreased from 89.8 minutes in cohort 1 to 70.1 minutes in cohort 2, with less than 5% change in OT after case 19. Time from incision to docking decreased from 9.5 minutes in cohort 1 to 7.6 minutes in cohort 2. The time required to dock the robotic system also decreased. The complication rate was the same in the two cohorts. Conclusion. Our survey indicates that technique and outcomes for robot-assisted sleeve gastrectomy gradually improve with experience. We found that the learning curve for performing a sleeve gastrectomy using the da Vinci system is completed after about 20 cases.

  14. Acylated and desacyl ghrelin are associated with hepatic lipogenesis, β-oxidation and autophagy: role in NAFLD amelioration after sleeve gastrectomy in obese rats.

    Science.gov (United States)

    Ezquerro, Silvia; Méndez-Giménez, Leire; Becerril, Sara; Moncada, Rafael; Valentí, Víctor; Catalán, Victoria; Gómez-Ambrosi, Javier; Frühbeck, Gema; Rodríguez, Amaia

    2016-12-23

    Bariatric surgery improves non-alcoholic fatty liver disease (NAFLD). Our aim was to investigate the potential role of ghrelin isoforms in the resolution of hepatic steatosis after sleeve gastrectomy, a restrictive bariatric surgery procedure, in diet-induced obese rats. Male Wistar rats (n = 161) were subjected to surgical (sham operation and sleeve gastrectomy) or dietary interventions [fed ad libitum a normal (ND) or a high-fat (HFD) diet or pair-fed]. Obese rats developed hepatosteatosis and showed decreased circulating desacyl ghrelin without changes in acylated ghrelin. Sleeve gastrectomy induced a dramatic decrease of desacyl ghrelin, but increased the acylated/desacyl ghrelin ratio. Moreover, sleeve gastrectomy reduced hepatic triglyceride content and lipogenic enzymes Mogat2 and Dgat1, increased mitochondrial DNA amount and induced AMPK-activated mitochondrial FFA β-oxidation and autophagy to a higher extent than caloric restriction. In primary rat hepatocytes, the incubation with both acylated and desacyl ghrelin (10, 100 and 1,000 pmol/L) significantly increased TG content, triggered AMPK-activated mitochondrial FFA β-oxidation and autophagy. Our data suggest that the decrease in the most abundant isoform, desacyl ghrelin, after sleeve gastrectomy contributes to the reduction of lipogenesis, whereas the increased relative acylated ghrelin levels activate factors involved in mitochondrial FFA β-oxidation and autophagy in obese rats, thereby ameliorating NAFLD.

  15. Acylated and desacyl ghrelin are associated with hepatic lipogenesis, β-oxidation and autophagy: role in NAFLD amelioration after sleeve gastrectomy in obese rats

    Science.gov (United States)

    Ezquerro, Silvia; Méndez-Giménez, Leire; Becerril, Sara; Moncada, Rafael; Valentí, Víctor; Catalán, Victoria; Gómez-Ambrosi, Javier; Frühbeck, Gema; Rodríguez, Amaia

    2016-01-01

    Bariatric surgery improves non-alcoholic fatty liver disease (NAFLD). Our aim was to investigate the potential role of ghrelin isoforms in the resolution of hepatic steatosis after sleeve gastrectomy, a restrictive bariatric surgery procedure, in diet-induced obese rats. Male Wistar rats (n = 161) were subjected to surgical (sham operation and sleeve gastrectomy) or dietary interventions [fed ad libitum a normal (ND) or a high-fat (HFD) diet or pair-fed]. Obese rats developed hepatosteatosis and showed decreased circulating desacyl ghrelin without changes in acylated ghrelin. Sleeve gastrectomy induced a dramatic decrease of desacyl ghrelin, but increased the acylated/desacyl ghrelin ratio. Moreover, sleeve gastrectomy reduced hepatic triglyceride content and lipogenic enzymes Mogat2 and Dgat1, increased mitochondrial DNA amount and induced AMPK-activated mitochondrial FFA β-oxidation and autophagy to a higher extent than caloric restriction. In primary rat hepatocytes, the incubation with both acylated and desacyl ghrelin (10, 100 and 1,000 pmol/L) significantly increased TG content, triggered AMPK-activated mitochondrial FFA β-oxidation and autophagy. Our data suggest that the decrease in the most abundant isoform, desacyl ghrelin, after sleeve gastrectomy contributes to the reduction of lipogenesis, whereas the increased relative acylated ghrelin levels activate factors involved in mitochondrial FFA β-oxidation and autophagy in obese rats, thereby ameliorating NAFLD. PMID:28008992

  16. Clinical implications of sleeve gastrectomy as a source of spleen infarction or ischemia.

    Science.gov (United States)

    Stamou, Konstantinos M; Menenakos, Evangelos; Gomatos, Ilias P; Panousopoulos, Sotirios-George D; Smparounis, Spyridon; Leandros, Emmanuel; Zografos, George

    2011-10-01

    Splenic arterial demarcation has been observed during laparoscopic sleeve gastrectomy (LSG). The present study aims to detect its actual incidence during LSG and clarify its clinical significance. This is a prospective observational study of 287 consecutive patients that underwent LSG by the same surgical team over 3 years. In all patients, the gastric fundus was mobilized using a standard technique. Before withdrawal of the pneumoperitoneum, the spleen was exposed and carefully inspected for evidence of arterial demarcation. Patients with a clear demarcation were followed with Doppler ultrasound. Computed tomography scan with oral contrast was performed to rule out septic complications. Median preoperative body mass index was 46 kg/m(2) (range 35.1-78). Median operative time was 58 min (range 42-185), median hospital stay was 3 days (range 3-45), and overall morbidity rate was 8.6%. Intraoperative demarcation of the upper splenic pole was evident in 12 patients (4.1%). Eleven patients had uneventful postoperative course. One patient raised temperature of 38.5°C at the 7th postoperative day and was readmitted for further treatment. Once afebrile, the patient was discharged on the 10th postoperative day and continued on prophylactic low molecular weight heparin (tinzaparin, 7,500 U sc.) for 20 days. Splenic discoloration following LSG is an uncommon complication with minimal clinical significance, which could be related to hematoma, venous congestion, or ischemia. The possibility of a late splenic abscess cannot be ruled out. No risk factors can be identified preoperatively.

  17. Pancreas volume reduction and metabolic effects in Japanese patients with severe obesity following laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Umemura, Akira; Sasaki, Akira; Nitta, Hiroyuki; Baba, Shigeaki; Ando, Taro; Kajiwara, Takashi; Ishigaki, Yasushi

    2017-03-17

    This study aimed to assess the relationship between the metabolic effect after laparoscopic sleeve gastrectomy (LSG) in morbidly obese Japanese patients, with or without type 2 diabetes mellitus (T2DM), and improved pancreatic steatosis (PS). The study enrolled 27 morbidly obese Japanese patients who were undergoing LSG. Their clinical and metabolic effects were evaluated at baseline and six months after LSG. Pancreas volume (PV), pancreatic attenuation (PA), and splenic attenuation (SA) were measured using a 64-row computed tomography (CT). Changes in PV, PA-SA, and PA/SA were evaluated. The mean body-weight loss, body mass index loss, and percentage of excess weight loss (%EWL) were -34.4 kg (p < 0.001), -11.0 kg/m(2) (p < 0.001), and 43.7%, respectively. The mean PV was 96.7 mL at baseline, and it decreased six months after LSG (-16.3mL, p < 0.001). The mean PA significantly increased six months after LSG (9.5 HU, p < 0.001). PA-SA (-23.2 HU vs. -13.3 HU, p = 0.003), and PA/SA (0.54 vs. 0.73, p < 0.001) also significantly increased six months after LSG. In T2DM patients, decreased PV correlated with decreased fasting blood sugar, decreased insulin, and reduced liver volume. In conclusion, PV significantly decreased after LSG in morbidly obese Japanese patients, and that decrease correlated with improvements in PS. In addition, PS plays an important role of development and progression of insulin resistance and T2DM.

  18. Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures

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    Ramon Vilallonga

    2015-01-01

    Full Text Available Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve. We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.

  19. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy

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    Berna Dogan

    2016-01-01

    Full Text Available Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG. Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40 who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT, total macular volume (TMV, and retinal ganglion cell layer (RGCL were measured by spectral-domain optical coherence tomography (SD-OCT. Subfoveal choroidal thickness (SFCT was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT. Results. The mean CMT was 237.4±24.5 μm, 239.3±24.1 μm, and 240.4±24.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean TMV was 9.88±0.52 mm3, 9.96±0.56 mm3, and 9.99±0.56 mm3 preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean RGCL was 81.2±6.5 μm, 82.7±6.6 μm, and 82.9±6.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean SFCT was 309.8±71.8 μm, 331.0±81.4 μm, and 352.7±81.4 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p=0.34, disc area (p=0.64, vertical cup/disc ratio (p=0.39, cup volume (p=0.08, or retinal nerve fiber layer (p=0.90. Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery.

  20. Achalasia: A case report on its effect during surgical decision making for laparoscopic sleeve gastrectomy in the young morbidly obese patient

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    Rodolfo J. Oviedo, MD, FACS

    2016-01-01

    Conclusion: The patient has already undergone a POEM procedure, which was chosen to maintain the gastric fundus, cardia, and gastroesophageal junction (GEJ architecture as opposed to a LHM with Dor fundoplication, which would have altered the anatomy, thus making a concomitant laparoscopic sleeve gastrectomy an unfeasible option.

  1. Effects of sleeve gastrectomy and rs9930506 FTO variants on angiopoietin/Tie-2 system in fat expansion and M1 macrophages recruitment in morbidly obese subjects.

    Science.gov (United States)

    Figueroa-Vega, Nicté; Jordán, Benjamín; Pérez-Luque, Elva Leticia; Parra-Laporte, Luis; Garnelo, Serafín; Malacara, Juan Manuel

    2016-12-01

    Angiogenesis in inflammation are hallmarks for adipose tissue expansion in obesity. The role of angiopoietin/Tie-2 system in adipose tissue expansion and immune cell recruitment is unclear. We studied the effect of sleeve gastrectomy and the influence of FTO rs9930506 polymorphism on Tie-2, angiopoietin-1 and angiopoietin-2 expression in morbid obesity. Fifteen morbidly obese subjects (4 men and 11 women) aged 24-55 years were followed-up 3 and 6 months after sleeve gastrectomy. Serum sTie-2, angiopoietin-1, angiopoietin-2, and hypoxia-inducible factor-1α concentrations were determined by ELISA. Tie-2 and its ligands in visceral and subcutaneous adipose tissue were localized by immunohistochemistry. Tie-2 expression was measured by flow cytometry in circulating monocytes and infiltrated macrophages. Comparisons before and after sleeve gastrectomy were carried out using ANOVA for repeated measures. rs9930506FTO genotyping was performed by PCR-RFLP. Circulating sTie-2 and angiopoietin-2 were higher before sleeve gastrectomy. Tie-2 and angiopoietin-2 mRNA levels were higher in subcutaneous adipose tissue than visceral and both decreased after surgery. Monocytes and infiltrated macrophages showed a pro-inflammatory phenotype, with increased Tie-2 expression that decreased 3 and 6 months after sleeve gastrectomy. Baseline sTie-2 correlated inversely with adiponectin levels. At baseline the rs9930506FTO AG ó GG genotypes carriers had more 34 kg than genotype carriers of rs9930506 AA. Weight and body mass index decreased at 6 months. We found that angiopoietin/Tie-2 system is mainly expressed in subcutaneous adipose tissue, contributing to expandability, fat accumulation, and monocytes attachment in obesity. Bariatric surgery favorably modifies the pro-angiogenic profile, allowed a reduced angiogenic expression in the circulation and adipose tissue.

  2. Insulin Resistance, Microbiota, and Fat Distribution Changes by a New Model of Vertical Sleeve Gastrectomy in Obese Rats.

    Science.gov (United States)

    Basso, Nicola; Soricelli, Emanuele; Castagneto-Gissey, Lidia; Casella, Giovanni; Albanese, Davide; Fava, Francesca; Donati, Claudio; Tuohy, Kieran; Angelini, Giulia; La Neve, Federica; Severino, Anna; Kamvissi-Lorenz, Virginia; Birkenfeld, Andrea L; Bornstein, Stefan; Manco, Melania; Mingrone, Geltrude

    2016-10-01

    Metabolic surgery improves insulin resistance and type 2 diabetes possibly because of weight loss. We performed a novel sleeve gastrectomy in rats that resects ∼80% of the glandular portion, leaving the forestomach almost intact (glandular gastrectomy [GG]) and compared subsequent metabolic remodeling with a sham operation. GG did not affect body weight, at least after 10 weeks; improved hepatic and peripheral insulin sensitivity likely through increased Akt, glycogen synthase kinase 3, and AMPK phosphorylation; and reduced ectopic fat deposition and hepatic glycogen overaccumulation. Body adipose tissue was redistributed, with reduction of intraabdominal fat. We found a reduction of circulating ghrelin levels, increased GLP-1 plasma concentration, and remodeling of gut microbiome diversity characterized by a lower relative abundance of Ruminococcus and a higher relative abundance of Lactobacillus and Collinsella These data suggest that at least in rat, the glandular stomach plays a central role in the improvement of insulin resistance, even if obesity persists. GG provides a new model of the metabolically healthy obese phenotype.

  3. Case report: Renal infarction by paradoxical embolism through the patent foramen ovale as an unusual cause of post-operative abdominal pain after sleeve gastrectomy

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    Oleksandr Khoma, Dr

    2016-01-01

    Full Text Available 50-year-old female presented with abdominal pain 9 days post sleeve gastrectomy and was found to have acute renal infarction caused by paradoxical emboli through patent foramen ovale (PFO as a cause of the renal infarction. Renal infarctions caused by paradoxical embolism are rare and have not been previously reported following surgery, bariatric surgery in particular. This report describes presentation, work up and management of a patient with renal infarct following bariatric surgery.

  4. Combined liver transplantation and sleeve gastrectomy for end-stage liver disease in a bariatric patient: First European case-report

    OpenAIRE

    2016-01-01

    Introduction: Obesity is a contributor to the global burden of chronic diseases, including non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH). NASH cirrhosis is becoming a leading indication for liver transplant (LT). Obese transplanted patients have higher morbidity and mortality rates. One strategy, to improve the outcomes in these patients, includes bariatric surgery at the time of LT. Herein we report the first European combined LT and sleeve gastrectomy (SG). C...

  5. The different effects of gastric banding and sleeve gastrectomy on obese rat%胃束带术和袖状胃切除术对营养性肥胖大鼠干预效果差异的研究

    Institute of Scientific and Technical Information of China (English)

    梁永康; 王兵

    2012-01-01

    Objective To evaluate the different effects of gastric banding (GB) and sleeve gastrectomy (SG) on diet-induced obese rat model.Methods The obese rat model was established via the diet-induced method,and then underwent SG,GB,or sham-operation (SO) procedures.The different effects of SG,GB,and SO on these rats were evaluated at the 14th,28th and 56th day after operation.Results After 7 weeks' feeding,31rats in high-diet group reached the modeling standard.The model success rate was 88.6% (31/35).GB and SG group showed significantly less cumulative food intake than SO group ( P < 0.01).There was no significant difference between GB and SG group in cumulative food intake ( P > 0.05 ).The average weight of rats in GB and SG group was (609.1±6.0) g and (591.6 ±4.3) g respectively at the 56th day after operation while it was (649.8 ± 10.0) g for SO group.The difference had statistical significance ( P < 0.01).SG group showed better improvement effects on TC,TG,FFA,LDL-c and HDL-c than GB group (P <0.05).The postoperative ghrelin level in GB and SG group all decreased constantly and it decreased slower in GB group than in SG group.At the 56th day after operation,the ghrelin level in GB and SG group reduced from (1151.0 ± 144.2) pg/ml and (1148.2±127.2) pg,/ml to (992.0+121.9) pg/ml (P<0.05) and (761.0+125.3) pg/ml (P<0.01) respectively.The leptin level in GB and SG group all showed decreasing tendency.However,the leptin level of the 2 groups presented significant difference at the 56th day after operation.Conclusions There is no significant difference between GB and SG group in postoperative cumulative food intake.However,SG has better effects on controlling weight gain and improving blood lipids than GB.The different effects of GB and SG on the level of ghrelin and leptin in rats may account for the different curative effects.%目的 探讨胃束带术(GB)和袖状胃切除术(SG)对营养性肥胖大鼠疗效的差异.方法 对饮食诱导方法建

  6. Excess Body Mass Index Loss at 3 Months: A Predictive Factor of Long-Term Result after Sleeve Gastrectomy

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    Guillaume Philouze

    2017-01-01

    Full Text Available Introduction. Laparoscopic Sleeve Gastrectomy (SG is considered as successful if the percentage of Excess Body Mass Index Loss (% EBMIL remains constant over 50% with long-term follow-up. The aim of this study was to evaluate whether early % EBMIL was predictive of success after SG. Methods. This retrospective study included patients who had SG with two years of follow-up. Patients had follow-up appointments at 3 (M3, 6, 12, and 24 months (M24. Data as weight and Body Mass Index (BMI were collected systematically. We estimated the % EBMIL necessary to establish a correlation between M3 and M24 compared to % EBMIL speeds and calculated a limit value of % EBMIL predictive of success. Results. Data at operative time, M3, and M24 were available for 128 patients. Pearson test showed a correlation between % EBMIL at M3 and that at M24 (r=0.74;  p<0.0001. % EBMIL speed between surgery and M3 (p=0.0011 was significant but not between M3 and M24. A linear regression analysis proved that % EBMIL over 20.1% at M3 (p<0.0001 predicted a final % EBMIL over 50%. Conclusions. % EBMIL at M3 after SG is correlated with % EBMIL in the long term. % EBMIL speed was significant in the first 3 months. % EBMIL over 20.1% at M3 leads to the success of SG.

  7. Determinants of Weight Loss following Laparoscopic Sleeve Gastrectomy: The Role of Psychological Burden, Coping Style, and Motivation to Undergo Surgery

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    Andrea Figura

    2015-01-01

    Full Text Available Background. The amount of excess weight loss (%EWL among obese patients after bariatric surgery varies greatly. However, reliable predictors have not been established yet. The present study evaluated the preoperative psychological burden, coping style, and motivation to lose weight as factors determining postoperative treatment success. Methods. The sample included 64 morbidly obese patients with a preoperative BMI of 51±8 kg/m2 who had undergone laparoscopic sleeve gastrectomy (LSG. Well-established questionnaires were applied before surgery to assess the psychological burden in terms of “perceived stress” (PSQ-20, “depression” (PHQ-9, “anxiety” (GAD-7, and “mental impairment” (ISR as well as coping style (Brief COPE and motivation to lose weight. %EWL as an indicator for treatment success was assessed on average 20 months after surgery. Results. Based on the %EWL distribution, patients were classified into three %EWL groups: low (14–39%, moderate (40–59%, and high (60–115%. LSG patients with high %EWL reported significantly more “active coping” behavior prior to surgery than patients with moderate and low %EWL. Patients’ preoperative psychological burden and motivation to lose weight were not associated with %EWL. Conclusion. An “active coping” style might be of predictive value for better weight loss outcomes in patients following LSG intervention.

  8. Single-Lobe Living Donor Liver Transplant in a Morbidly Obese Cirrhotic Patient Preceded by Laparoscopic Sleeve Gastrectomy

    Science.gov (United States)

    Gupta, Subash; Wadhawan, Manav; Goyal, Neerav

    2013-01-01

    Nonalcoholic steatohepatitis (NASH) is a stage of nonalcoholic fatty liver disease (NAFLD), and, in most patients, it is associated with obesity and metabolic syndrome with progression to end-stage liver disease in about 20% of patients (McCullough (2004); Matteoni et al. (1999); Liou and Kowdley (2006)). It has been estimated that between 20 and 30% of patients with end-stage cirrhosis referred for liver transplantation (LT) evaluation and 30 to 70% of LT recipients exhibit some degree of obesity (Muñoz and ElGenaidi (2005)). Management of obesity in chronic liver disease patients is not only difficult but also preludes them from undergoing major bariatric surgery due to associated high morbidity and mortality. Here, we present a case report of a morbidly obese patient who underwent laparoscopic sleeve gastrectomy followed by single-lobe living donor liver transplantation (LDLT) with a successful outcome. We believe that this is the first report of successful LDLT following planned weight loss to facilitate LDLT. PMID:24386588

  9. Determinants of Secondary Hyperparathyroidism in Bariatric Patients after Roux-en-Y Gastric Bypass or Sleeve Gastrectomy: A Pilot Study

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    Andreas Alexandrou

    2015-01-01

    Full Text Available Objective. Nutritional deficiencies are common after bariatric surgery. We aimed to assess the prevalence and possible predictors of secondary hyperparathyroidism (SHPT in bariatric patients. Methods. A total of 95 patients who had undergone Roux-en-Y gastric bypass (RYGB or sleeve gastrectomy (SG were assessed after a median of 3 years after surgery. Anthropometric/demographic and weight-loss parameters were compared according to the presence of SHPT, independently for men/premenopausal women and postmenopausal women. Results. SHPT was highly prevalent (men/premenopausal women, 52.1%; postmenopausal women, 31.9%. Among men/premenopausal women, multivariate analysis indicated that SHPT was predicted by (a 25-hydroxyvitamin D levels (Exp(B = 0.869, P-value = 0.037, independently of age, sex, smoking; (b calcium (Exp(B = 0.159, P-value = 0.033 and smoking, independently of age and sex; (c magnesium (Exp(B = 0.026, P-value = 0.046 and smoking, independently of age and sex. Among postmenopausal women, SHPT was predicted by menopausal age independently of age, smoking, and levels of 25-hydroxyvitamin D or calcium. The development of SHPT was not associated with the type of surgery. Conclusions. RYGB and SG exhibited similar effects regarding the regulation of the hypothalamus-pituitary-parathyroid axis after surgery. Vitamin D status and menopausal age appear to determine SHPT on the long term. SHPT should be sought and vigorously treated with calcium and vitamin D supplementation.

  10. A rare cause of bleeding after laparoscopic sleeve gastrectomy : pseudo-aneurysm of the gastro-omental artery.

    Science.gov (United States)

    Mege, D; Louis, G; Berthet, B

    2013-01-01

    A serious complication of laparoscopic sleeve gastrectomy (LSG) is bleeding that is primarily located along the staples lines. Bleeding may be due to several causes, including hematomas, trocar sites, or visceral pseudo-aneurysms. We reported here a case of bleeding related to a pseudo-aneurysm of the gastro-omental artery. An LSG was performed on a 43-year-old woman (BMI = 46 kg/m2) without apparent surgical complications. Fifteen days later, she was admitted to the emergency department for hematemesis and symptoms of hemorrhagic shock. Abdominal computed tomography angiography revealed blood in the stomach, without a digestive leak, and active bleeding from a pseudo-aneurysm of the gastro-omental artery. An arterial embolisation was performed with the sandwich technique and angiographic guide wires and the placement of several detachable coils. The patient was discharged two days later. We demonstrated for the first time that post-LSG bleeding may involve a pseudo-aneurysm of the gastro-omental artery.

  11. Indications and mid-term results of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass.

    Science.gov (United States)

    Gautier, Thomas; Sarcher, Thomas; Contival, Nicolas; Le Roux, Yannick; Alves, Arnaud

    2013-02-01

    Sleeve gastrectomy (SG) is currently considered as a primary bariatric surgery. This is because of its relative simplicity and satisfactory results. As observed with other bariatric procedures, surgeons are confronted with insufficient weight loss or weight regain, insufficient resolution of metabolic disorders, and intractable severe reflux. A retrospective analysis of conversion from SG to Roux-en-Y gastric bypass (RYGBP) was performed to assess weight loss, diabetes resolution, and relief of reflux symptoms. The mean interval between the two procedures was almost 24 months. Eighteen patients underwent conversion from SG to RYGBP for insufficient weight loss (n = 9), severe reflux (n = 6), and persistence of type 2 diabetes mellitus (T2DM) (n = 3). The median follow-up was 15.5 months. Weight loss was significantly improved with a mean percentage of excess of body mass index loss at 64.6 % after conversion versus 47.1 % before conversion. All reflux symptoms were immediately relieved without any medication at the end of the follow-up. The three patients who had an operation for persistence of T2DM are now free of medication. Only one postoperative complication was observed as a small bowel injury, which was treated surgically. Conversion from SG to RYGBP is safe. Severe reflux is definitely treated and is an incontestable indication with this procedure. Additionally, weight loss and diabetes are clinically improved. Our results appear to be similar to those with a primary RYGBP.

  12. 袖状胃切除术治疗重度肥胖症进展%New progresses of sleeve gastrectomy for morbid obesity

    Institute of Scientific and Technical Information of China (English)

    邢颖; 白日星

    2014-01-01

    随着肥胖人群的增加,减肥手术的应用逐渐广泛,袖状胃切除术作为一种相对较新的术式,由于其术式简单,手术风险小且效果良好,近年来受到了越来越多的减肥外科医师和肥胖患者关注。本文从患者选择、手术技巧、效果、并发症等方面介绍袖状胃切除术的最新进展。%Bariatric surgery is used more and more widely as the population of obesity is increasing, sleeve gastrectomy is a relatively new kind of bariatric surgery, which grows more popular for its perceived technical simplicity, feasibility, and good outcomes. This article introduces new progresses of sleeve gastrectomy in patient selection, surgical technique, effectiveness, and complications.

  13. Vertical sleeve gastrectomy

    Science.gov (United States)

    ... 5 and 25. A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are obstructive sleep apnea , type 2 diabetes , and heart disease . Vertical ...

  14. Comparison of weight loss outcomes 1 year after sleeve gastrectomy and Roux-en-Y gastric bypass in patients aged above 50 years

    Directory of Open Access Journals (Sweden)

    Palanivelu Praveenraj

    2016-01-01

    Full Text Available Introduction: Safe, effective weight loss with resolution of comorbidities has been convincingly demonstrated with bariatric surgery in the aged obese. They, however, lose less weight than younger individuals. It is not known if degree of weight loss is influenced by the choice of bariatric procedure. The aim of this study was to compare the degree of weight loss between laparoscopic sleeve gastrectomy (LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB in patients above the age of 50 years at 1 year after surgery. Materials and Methods: A retrospective analysis was performed of all patients more than 50 years of age who underwent LSG or LRYGB between February 2012 and July 2013 with at least 1 year of follow-up. Data evaluated at 1 year included age, sex, weight, body mass index (BMI, mean operative time, percentage of weight loss and excess weight loss, resolution/remission of diabetes, morbidity and mortality. Results: Of a total of 86 patients, 54 underwent LSG and 32 underwent LRYGB. The mean percentage of excess weight loss at the end of 1 year was 60.19 ± 17.45 % after LSG and 82.76 ± 34.26 % after LRYGB (P = 0.021. One patient developed a sleeve leak after LSG, and 2 developed iron deficiency anaemia after LRYGB. The remission/improvement in diabetes mellitus and biochemistry was similar. Conclusion: LRYGB may offer better results than LSG in terms of weight loss in patients over 50 years of age.

  15. Comparison of weight loss outcomes 1 year after sleeve gastrectomy and Roux-en-Y gastric bypass in patients aged above 50 years

    Science.gov (United States)

    Praveenraj, Palanivelu; Gomes, Rachel M; Kumar, Saravana; Perumal, Sivalingam; Senthilnathan, Palanisamy; Parthasarathi, Ramakrishnan; Rajapandian, Subbiah; Palanivelu, Chinnusamy

    2016-01-01

    INTRODUCTION: Safe, effective weight loss with resolution of comorbidities has been convincingly demonstrated with bariatric surgery in the aged obese. They, however, lose less weight than younger individuals. It is not known if degree of weight loss is influenced by the choice of bariatric procedure. The aim of this study was to compare the degree of weight loss between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients above the age of 50 years at 1 year after surgery. MATERIALS AND METHODS: A retrospective analysis was performed of all patients more than 50 years of age who underwent LSG or LRYGB between February 2012 and July 2013 with at least 1 year of follow-up. Data evaluated at 1 year included age, sex, weight, body mass index (BMI), mean operative time, percentage of weight loss and excess weight loss, resolution/remission of diabetes, morbidity and mortality. RESULTS: Of a total of 86 patients, 54 underwent LSG and 32 underwent LRYGB. The mean percentage of excess weight loss at the end of 1 year was 60.19 ± 17.45 % after LSG and 82.76 ± 34.26 % after LRYGB (P = 0.021). One patient developed a sleeve leak after LSG, and 2 developed iron deficiency anaemia after LRYGB. The remission/improvement in diabetes mellitus and biochemistry was similar. CONCLUSION: LRYGB may offer better results than LSG in terms of weight loss in patients over 50 years of age. PMID:27279392

  16. BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35–60 kg/m2 – a multi-centre randomized patient and observer blind non-inferiority trial

    OpenAIRE

    2015-01-01

    Background: Roux-en-Ygastric bypass (RYGB) and sleeve gastrectomy (SG) rank among the most frequently applied bariatric procedures worldwide due to their positive risk/benefit correlation. A systematic review revealed a similar excess weight loss (EWL) 2 years postoperatively between SG and RYGB. However, there is a lack of randomized controlled multi-centre trials comparing SG and RYGB, not only concerning EWL, but also in terms of remission of obesity-related co-morbidities, gastroesophagea...

  17. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm

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    Palanivelu Praveenraj

    2016-01-01

    Full Text Available Background: Laparoscopic sleeve gastrectomy (LSG is the most commonly performed 'standalone' bariatric procedure in India. Staple line gastric leaks occur infrequently but cause significant and prolonged morbidity. The aim of this retrospective study was to analyse the management of patients with a gastric leak after LSG for morbid obesity at our institution. Patients and Methods: From February 2008 to 2014, 650 patients with different degrees of morbid obesity underwent LSG. Among these, all those diagnosed with a gastric leak were included in the study. Patients referred to our institution with gastric leak after LSG were also included. The time of presentation, site of leak, investigations performed, treatment given and time of closure of all leaks were analysed. Results: Among the 650 patients who underwent LSG, 3 (0.46% developed a gastric leak. Two patients were referred after LSG was performed at another institution. The mean age was 45.60 ± 15.43 years. Mean body mass index (BMI was 44.79 ± 5.35. Gastric leak was diagnosed 24 h to 7 months after surgery. One was early, two were intermediate and two were late leaks. Two were type I and three were type II gastric leaks. Endoscopic oesophageal stenting was used variably before or after re-surgery. Re-surgery was performed in all and included stapled fistula excision (re-sleeve, suture repair only or with conversion to roux-en-Y gastric bypass or fistula jujenostomy. There was no mortality. Conclusion: Leakage closure time may be shorter with intervention than expectant management. Sequence and choice of endoscopic oesophageal stenting and/or surgical re-intervention should be individualized according to clinical presentation.

  18. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study of 117 patients.

    Science.gov (United States)

    Leyba, Jose Luis; Aulestia, Salvador Navarrete; Llopis, Salvador Navarrete

    2011-02-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. In this study, we prospectively compared both techniques in order to establish whether there is any superiority of one over the other based on morbidity and effectiveness. From January 2008 to December 2008, 117 obese patients with indication for bariatric surgery were assigned by patient choice after informed consent to either a LRYGB procedure (n = 75) or a LSG procedure (n = 42). We determined operative time, length of stay, morbidity, co-morbidity outcomes, and excess weight loss at 1 year postoperative. Both groups were comparable in age, sex, body mass index, and co-morbidities. Mean operative time of LSG was 82 min while LRYGB was 98 min (p  0.05). One year after surgery, average excess weight loss was 86% in LRYGB and 78.8% in LSG (p > 0.05). In the short term, both techniques are comparable regarding safety and effectiveness, so not one procedure is clearly superior to the other.

  19. [Quality of the diet of women with severe and morbid obesity undergoing gastric bypass and sleeve gastrectomy].

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    Basfi-fer, Karen; Valencia, Alejandra; Rojas, Pamela; Codoceo, Juana; Inostroza, Jorge; Vega, Claudia; Díaz, Emma; Adjemian, Andrea Riffo Daniela; Papapietro, Attila Csendes Karin; Carrasco, Fernando; Ruz, Manuel

    2011-03-01

    The objective of this study was to evaluate the changes of dietary intake and quality of the diet in patients undergoing gastric bypass and sleeve surgery. In 36 women with severe and morbid obesity it was assessed their nutrient intakes and dietary quality before and 6 months after bariatric surgery through three-day food records. Vitamin and mineral intakes from supplements were strictly controlled. Energy and nutrient intakes were significantly decreased 6 months after surgery bypass compared to the pre-surgery period with the exceptions of calcium and vitamin C. No differences were observed between groups. The Dietary quality index was also similar in both groups. Dietary intakes of calcium, iron, zinc, copper, folic acid, vitamin C, and vitamin E were below 100% of adequacy from at the 6th month after the surgery. Nevertheless, by considering both diet and supplements supply, nutrient adequacy of all but calcium and folic acid was above 100% in both groups. Gastric bypass patients presented greater values. In conclusion, these patients present an important reduction of their energy and nutrient intakes, with no major impact of the type of surgery. Supplement characteristics are crucial to cover nutritional needs.

  20. IFN-γ secretion in gut of Ob/Ob mice after vertical sleeve gastrectomy and its function in weight loss mechanism.

    Science.gov (United States)

    Du, Jin-Peng; Wang, Geng; Hu, Chao-Jie; Wang, Qing-Bo; Li, Hui-Qing; Xia, Wen-Fang; Shuai, Xiao-Ming; Tao, Kai-Xiong; Wang, Guo-Bin; Xia, Ze-Feng

    2016-06-01

    Vertical sleeve gastrectomy (VSG) is becoming more and more popular among the world. Despite its dramatic efficacy, however, the mechanism of VSG remains largely undetermined. This study aimed to test interferon (IFN)-γ secretion n of mesenteric lymph nodes in obese mice (ob/ob mice), a model of VSG, and its relationship with farnesoid X receptor (FXR) expression in the liver and small intestine, and to investigate the weight loss mechanism of VSG. The wild type (WT) mice and ob/ob mice were divided into four groups: A (WT+Sham), B (WT+VSG), C (ob/ob+Sham), and D (ob/ob+VSG). Body weight values were monitored. The IFN-γ expression in mesenteric lymph nodes of ob/ob mice pre- and post-operation was detected by flow cytometry (FCM). The FXR expression in the liver and small intestine was detected by Western blotting. The mouse AML-12 liver cells were stimulated with IFN-γ at different concentrations in vitro. The changes of FXR expression were also examined. The results showed that the body weight of ob/ob mice was significantly declined from (40.6±2.7) g to (27.5±3.8) g on the 30th day after VSG (Psecretion of IFN-γ in mesenteric lymph nodes of ob/ob mice than that pre-operation (Psmall intestine after VSG were respectively 0.97±0.07 and 0.84±0.07 fold of GAPDH, which were significantly higher than pre-operative levels of 0.50±0.06 and 0.48±0.06 respectively (Psecretion of mesenteric lymph nodes, which then increases the FXR expression of the liver and small intestine.

  1. Laparoscopic Sleeve Gastrectomy for Mildly Obese Patients (Body Mass Index of 30 <35 kg/m2: Operative Outcome and Short-Term Results

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    Roger Noun

    2012-01-01

    Full Text Available Background. Data concerning laparoscopic sleeve gastrectomy (LSG in mild obesity are under investigation. Aim/Objective. May 2010 to May 2012, 122 consecutive patients with preoperative body mass index (BMI of 33±2.5 kg/m2 (range 30–34.9 undergoing LSG were studied. Mean age was 33±10 years (range 15–60, and 105 (86% were women. Mean preoperative weight was 91±9.7 kg (range 66–121, and preoperative excess weight was 30±6.7 kg (range 19–43. Comorbidities were detected in 44 (36% patients. Results. Mean operative time was 58±15 min (range 40–95, and postoperative stay was 1.8±0.19 days (range 1.5–3. There were no admissions to intensive care unit and no deaths within 30 days of surgery. The rates of leaks and strictures were 0%, and of hemorrhage 1.6%. At 12 months, BMI decreased to 24.7±2, and the percentage of excess weight loss (% EWL reached 76.5%. None of the patients had a BMI below 20 kg/m2. Comorbidities resolved in 70.5% or improved in 29.5%. Patient satisfaction scoring (1–5 at least 1 year after was 4.6±0.8 for body image and 4.4±0.6 for food tolerance. Conclusion. LSG for mildly obese patients has proved to be technically relatively easy, safe, and benefic in the short term.

  2. Remodeling of the residual gastric mucosa after roux-en-y gastric bypass or vertical sleeve gastrectomy in diet-induced obese rats.

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    Konstantinos Arapis

    Full Text Available Whereas the remodeling of intestinal mucosa after bariatric surgeries has been the matter of numerous studies to our knowledge, very few reported on the remodeling of the residual gastric mucosa. In this study, we analyzed remodeling of gastric mucosa after Roux-en-Y gastric bypass (RYGB and vertical sleeve gastrectomy (VSG in rats. Diet-induced obese rats were subjected to RYGB, VSG or sham surgical procedures. All animals were assessed for food intake, body-weight, fasting blood, metabolites and hormones profiling, as well as insulin and glucose tolerance tests before and up to 5 weeks post-surgery. Remodeling of gastric tissues was analyzed by routine histology and immunohistochemistry studies, and qRT-PCR analyses of ghrelin and gastrin mRNA levels. In obese rats with impaired glucose tolerance, VSG and RYGB caused substantial weight loss and rats greatly improved their oral glucose tolerance. The remaining gastric mucosa after VSG and gastric pouch (GP after RYGB revealed a hyperplasia of the mucous neck cells that displayed a strong immunoreactivity for parietal cell H+/K+-ATPase. Ghrelin mRNA levels were reduced by 2-fold in remaining fundic mucosa after VSG and 10-fold in GP after RYGB. In the antrum, gastrin mRNA levels were reduced after VSG in line with the reduced number of gastrin positive cells. This study reports novel and important observations dealing with the remaining gastric mucosa after RYGB and VSG. The data demonstrate, for the first time, a hyperplasia of the mucous neck cells, a transit cell population of the stomach bearing differentiating capacities into zymogenic and peptic cells.

  3. Effect of Bariatric Sleeve Gastrectomy Technique on Women’s Lower Urinary Tract Symptoms and Quality of Life: A Prospective Study

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    Fatih Uruç

    2016-09-01

    Full Text Available Objective Obesity triggers lower urinary tract symptoms (LUTS secondary to accumulation of excess fat which may lead to increase in intra-abdominal/intravesical pressures and subsequent impairment in pelvic floor muscles. However, it is considered that weight loss resolve these symptoms. In this study, we aimed to investigate the effects of bariatric surgery and especially Sleeve gastrectomy (SG on women’s LUTS, and quality of life. Materials and Methods A total of 53 patients who have undergone laparoscopic SG in our clinics between April 2014 and March 2015 were included in this prospective study. Age, body weight and body mass index (BMI of the participants were preoperatively and postoperatively recorded. The patients have pre/post-operatively filled the Beck depression inventory (BDI, International prostate symptom score (IPSS, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF and the 36-Item Short Form health survey (SF-36 scores were recorded. Additionally, post-operative decrease in body weight and BMI of the patients was recorded. Results There was a statistically significant decrease in mean BDI, IPSS and ICIQ-SF scores and SF-36 (prominent increment in physical and mental component summary (PCS and MCS scores, when compared with pre-operative values. A positive correlation was found between BMI and parameters including age, BDI and IPSS. However, no significant correlation was present between BMI and the parameters including ICIQ-SF, PCS and MCS. Conclusion Negative effect of obesity on LUTS and quality of life cannot be ignored. We assume that bariatric surgery can induce dramatic weight loss, amelioration in symptoms of urinary dysfunction and increase in quality of life of women.

  4. Lower fetuin-A, retinol binding protein 4 and several metabolites after gastric bypass compared to sleeve gastrectomy in patients with type 2 diabetes.

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    Mia Jüllig

    Full Text Available BACKGROUND: Bypass of foregut secreted factors promoting insulin resistance is hypothesized to be one of the mechanisms by which resolution of type 2 diabetes (T2D follows roux-en-y gastric bypass (GBP surgery. AIM: To identify insulin resistance-associated proteins and metabolites which decrease more after GBP than after sleeve gastrectomy (SG prior to diabetes remission. METHODS: Fasting plasma from 15 subjects with T2D undergoing GBP or SG was analyzed by proteomic and metabolomic methods 3 days before and 3 days after surgery. Subjects were matched for age, BMI, metformin therapy and glycemic control. Insulin resistance was calculated using homeostasis model assessment (HOMA-IR. For proteomics, samples were depleted of abundant plasma proteins, digested with trypsin and labeled with iTRAQ isobaric tags prior to liquid chromatography-tandem mass spectrometry analysis. Metabolomic analysis was performed using gas chromatography-mass spectrometry. The effect of the respective bariatric surgery on identified proteins and metabolites was evaluated using two-way analysis of variance and appropriate post-hoc tests. RESULTS: HOMA-IR improved, albeit not significantly, in both groups after surgery. Proteomic analysis yielded seven proteins which decreased significantly after GBP only, including Fetuin-A and Retinol binding protein 4, both previously linked to insulin resistance. Significant decrease in Fetuin-A and Retinol binding protein 4 after GBP was confirmed using ELISA and immunoassay. Metabolomic analysis identified significant decrease of citrate, proline, histidine and decanoic acid specifically after GBP. CONCLUSION: Greater early decrease was seen for Fetuin-A, Retinol binding protein 4, and several metabolites after GBP compared to SG, preceding significant weight loss. This may contribute to enhanced T2D remission observed following foregut bypass procedures.

  5. Comparison of the short-term efficacies of laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy in the treatment of obesity combined with type 2 diabetes mellitus%腹腔镜可调节胃束带术与胃袖状切除术治疗肥胖症合并2型糖尿病的近期疗效比较

    Institute of Scientific and Technical Information of China (English)

    王鑫; 常绪生; 印慨; 卓光鑽; 郑成竹

    2014-01-01

    Objective To compare the short-term efficacies of laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity and type 2 diabetes mellitus,and to investigate the relationship between the body weight loss and the decrease of glucose of the 2 treatment methods.Methods The clinical data of 40 patients with obesity combined with type 2 diabetes mellitus who were admitted to the Changhai Hospital of the Second Military Medical University from January 2010 to December 2011 were retrospectively analyzed.There were 14 patients treated by LAGB (LAGB group) and 26 by LSG (LSG group).The body weight loss and the decrease of glucose at postoperative year 1 of the 2 groups were compared.The differences in the body weight and glucose before and after operation within groups were compared using the paired t test,and the differences in the body weight and glucose between the 2 groups were compared using the multiple analysis of variance.The correlation between the body weight loss and the decrease of glucose was analyzed using the linear regression analysis.Results Laparoscopic surgery was successfully done without conversion to open surgery or intraoperative complications.The operation time and volume of blood loss were (69 ± 16)minutes and (31 ± 14)mL in the LAGB group,(120 ± 15) minutes and (148 ± 48) mL in the LSG group.Complications including postoperative malnutrition,electrolyte disturbance,delayed gastric emptying,bleeding,anastomotic leakage did not occurr in the 2 groups.Two patients were complicated with abdominal incision fat liquefaction,and were cured by symptomatic treatment.(1) The body weight,body mass index (BMI) and waistline had a decrease trend.The body weight,BMI and waistline in the LAGB group were decreased from (117 ± 28)kg,(40 ± 8)kg/m2 and (118 ± 15) cm before operation to (94 ± 28) kg,(33 ± 8) kg/m2 and (92 ± 15) cm at postoperative week 48.The body weight,BMI and waistline in the LSG

  6. 腹腔镜袖状胃切除术在减重与代谢外科中应用的评价%Evaluation of the application of laparoscopic sleeve gastrectomy in bariatric and metabolic surgery

    Institute of Scientific and Technical Information of China (English)

    许博; 姚琪远

    2013-01-01

    Bariatric surgery is one of the most effective treatment options for obesity and type 2 diabetes mellitus.In recent years,laparoscopic sleeve gastrectomy has become increasingly popular due to simple operation,high safety and significant efficacy.In this article,the progress and the application evaluation of laparoscopic sleeve gastrectomy for the treatment of obesity and type 2 diabetes mellitus in the field of bariatric and metabolic surgery are reviewed.%大量临床资料证明,减重-代谢手术是治疗肥胖及2型糖尿病长期有效的方法.其中腹腔镜袖状胃切除术由于操作简便、安全性高且疗效明显,近年来得到了迅速普及.随着相关研究的开展,减重与代谢外科领域对该术式的认识逐渐深入.本文就腹腔镜袖状胃切除术在减重与代谢外科中的应用现状做一文献综述.

  7. Bariatric surgery in old age: a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence

    Institute of Scientific and Technical Information of China (English)

    Chih-Kun Huang; Amit Garg; Hsin-Chih Kuao; Po-Chih Chang; Ming-Che Hsin

    2015-01-01

    Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) in patients aged more than 55 years.We performed a retrospective review of a prospectively collected database.All patients with body mass index (BMI) > 32 kg/m2 and aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis.Demography,peri-operative data,weight loss and surgical complications were all recorded and analyzed.Mean age and BMI of these 68 patients (22 males and 46 female) were 58.8 years (55-79 years) and 39.5 kg/m2 (32.00-60.40 kg/m2).LRYGB was performed in 44 patients and LSG in 24 patients.The two groups were comparable in their preoperative BMI,American Society of Anaesthesia (ASA) score and gender distribution.LSG patients were significantly older than patients receiving LRYGB.The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients (88.63% vs.50%; P < 0.01).The prevalence of other co-morbidities was similar and comparable between the groups.Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/m2 and 28.2 kg/m2,respectively,and there was no statistically significant difference in mean percentage of excess weight loss (%EWL) at 1 year.The percentage of resolution of diabetes was significantly higher in LRYGB (69.2%) as compared to LSG (33.3%).On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver hepatitis.The overall morbidity and re-operation rate was higher in LRYGB patients.In morbidly elderly patients,both surgeries achieved good weight loss and

  8. Comparing Outcomes of Two Types of Bariatric Surgery in an Adolescent Obese Population: Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy

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    Giovana D Maffazioli

    2016-07-01

    Full Text Available Background: Obesity is prevalent among adolescents and is associated with serious health consequences. Roux-en-Y Gastric Bypass (RYGB and Sleeve Gastrectomy (SG are bariatric procedures that cause significant weight loss in adults and are increasingly being performed in adolescents with morbid obesity. Data comparing outcomes of RYGB versus SG in this age-group are scarce. This study aims to compare short-term (1-6 months and longer-term (7-18 months body mass index (BMI and biochemical outcomes following RYGB and SG in adolescents/young adults.Methods: A retrospective study using data extracted from medical records of patients 16-21 years who underwent RYGB or SG between 2012-2014 at a tertiary care academic medical center. Results: Forty-six patients were included in this study: 24 underwent RYGB and 22 underwent SG. Groups did not differ for baseline age, sex, race or BMI. BMI reductions were significant at 1-6 months and 7-18 months within groups (p<0.0001, but did not differ by surgery type (p= 0.65 and 0.09, for 1-6 months and 7-18 months, respectively. Over 7-18 months, within-group improvement in low density lipoprotein (LDL (-24±6 in RYGB, p=0.003, vs. -7±9mg/dL in SG, p=0.50 and non-high density lipoprotein (non-HDL cholesterol (-23±8 in RYGB, p=0.02, vs. -12±7 in SG, p=0.18 appeared to be of greater magnitude following RYGB. However, differences between groups did not reach statistical significance. When divided by non-alcoholic steatohepatitis stages (NASH, patients with Stage II-III NASH had greater reductions in ALT levels vs. those with Stage 0-I NASH (-45±18 vs -9±3, p=0.01 after 7-18 months. RYGB and SG groups did not differ for the magnitude of post-surgical changes in liver enzymes. Conclusion: RYGB and SG did not differ for the magnitude of BMI reduction across groups, though changes trended higher following RYGB. Further prospective studies are needed to confirm these findings.

  9. Sleeve gastrectomy versus Roux-en-Y gastric bypass for type 2 diabetes and morbid obesity: double-blind randomised clinical trial protocol

    Science.gov (United States)

    Murphy, Rinki; Evennett, Nicholas J; Clarke, Michael G; Robinson, Steven J; Humphreys, Lee; Jones, Bronwen; Kim, David D; Cutfield, Richard; Plank, Lindsay D; Hammodat, Hisham; Booth, Michael W C

    2016-01-01

    Introduction Type 2 diabetes (T2D) in association with obesity is an increasing disease burden. Bariatric surgery is the only effective therapy for achieving remission of T2D among those with morbid obesity. It is unclear which of the two most commonly performed types of bariatric surgery, laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), is most effective for obese patients with T2D. The primary objective of this study is to determine whether LSG or LRYGB is more effective in achieving HbA1c<6% (<42 mmol/mol) without the use of diabetes medication at 5 years. Methods and analysis Single-centre, double-blind (assessor and patient), parallel, randomised clinical trial (RCT) conducted in New Zealand, targeting 106 patients. Eligibility criteria include age 20–55 years, T2D of at least 6 months duration and body mass index 35–65 kg/m2 for at least 5 years. Randomisation 1:1 to LSG or LRYGB, used random number codes disclosed to the operating surgeon after induction of anaesthesia. A standard medication adjustment schedule will be used during postoperative metabolic assessments. Secondary outcomes include proportions achieving HbA1c<5.7% (39 mmol/mol) or HbA1c<6.5% (48 mmol/mol) without the use of diabetes medication, comparative weight loss, obesity-related comorbidity, operative complications, revision rate, mortality, quality of life, anxiety and depression scores. Exploratory outcomes include changes in satiety, gut hormone and gut microbiota to gain underlying mechanistic insights into T2D remission. Ethics and dissemination Ethics approval was obtained from the New Zealand regional ethics committee (NZ93405) who also provided independent safety monitoring of the trial. Study commenced in September 2011. Recruitment completed in October 2014. Data collection is ongoing. Results will be reported in manuscripts submitted to peer-reviewed journals and in presentations at national and international meetings

  10. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients. Results of a multicenter prospective study at 1 year.

    Science.gov (United States)

    Nocca, David; Guillaume, Fabre; Noel, Patrick; Picot, Marie Christine; Aggarwal, Rajesh; El Kamel, Moez; Schaub, Roxanne; de Seguin de Hons, Charles; Renard, Eric; Fabre, Jean Michel

    2011-06-01

    Gastric bypass (GBP) has proved its efficacy 30 years ago in the management of diabetes mellitus (T2DM) for severe obese patients. More recently, interesting results have been published after sleeve gastrectomy (SG) in the same indication. Between 2005 and 2008, three bariatric centers have prospectively collected the data of T2DM patients treated by laparoscopic gastric bypass (LGBP) or laparoscopic sleeve gastrectomy (LSG). Effects on hemoglobin A1c (HbA1c), pharmacological treatment and excess weight loss after 1 year of surgery have been analyzed. All patients (35 LGBP and 33 LSG) were treated with oral anti-diabetics (OAD) or insulin before surgery (32 OAD and three insulin in LGBP group and 27 OAD and six insulin in LSG group). The average body mass index (BMI) in the LGBP group was 47.9 and 50.6 kg/m² in the LSG group. At 1 year after surgery, the average HbA1c lost was 2,537 in the GBP group and 2,175 in the SG group. T2DM had resolved (withdrawal of pharmacological treatment) in 60% of the LGBP group and 75.8% of the LSG group. Reduced use of pharmacological therapy was noted in 31.42% of the LGBP group and 15.15% of the LSG group. Percentage excess weight loss and BMI lost were 56.35% and 29.75% in the LGBP group and 60.11% and 29.80% in the LSG group, respectively. During short-term follow-up, the impact on regulation of HbA1c blood level of LGBP or LSG is important. At 1 year after surgery, LSG seems to be as effective as LGBP for the management of T2DM in severely obese patients.

  11. Comparative study between laparoscopic gastric bypass and sleeve gastrectomy for simple obesity%腹腔镜胃旁路术与袖状胃切除术治疗单纯性肥胖症的对比研究

    Institute of Scientific and Technical Information of China (English)

    张光辉; 张进峰; 周宏建; 张春明

    2015-01-01

    目的探讨腹腔镜Roux-en-Y胃旁路术和腹腔镜袖状胃切除术治疗单纯性肥胖症的疗效差异。方法回顾性分析2010年8月至2012年12月在郑州市第二人民医院接受减肥手术治疗的单纯性肥胖患者的临床资料,其中接受腹腔镜胃旁路术28例,接受袖状胃切除术9例,临床检测指标包括术后6个月、12个月、24个月的BMI、空腹血糖水平(FPG)、血红蛋白(HGB)和微量元素(Ca2+、Fe2+、VitB12)。结果两组患者的手术时间存在明显差异(P<0.05),术后6个月、12个月、24个月的BMI、FPG、HGB和微量元素水平均未见明显差异。结论腹腔镜Roux-en-Y胃旁路术和袖状胃切除术均有确切的减肥疗效,疗效差异仍有待于更大样本更长时间的深入研究以发现。%Objective To explore the difference of efficacy between laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for simple obesity.Methods Clinical data of simple obese patients undergoing bariatric surgeries in the Second Hospital of Zhengzhou from August 2010 to December 2012 were retrospectively studied, including laparoscopic Roux-en-Y gastric bypass group (n=28) and sleeve gastrectomy group (n=9). Clinical data included BMI、FPG、HGB、microelements (Ca2+、Fe2+、VitB12) at 6、12、24 months postoperatively.Results There was statistical difference in operation time (P<0.05), but the levels of BMI、FPG、HGB and microelements had no statistical differences at 6、12、24 months postoperatively between the two groups.Conclusions Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy have a definite effect for simple obesity. Longer investigation duration and larger sample size are needed to verify the long-term differences between the two groups.

  12. Understanding of International Sleeve Gastrectomy Expert Panel Consensus Statement and our experience%对《国际袖状胃切除术专家组共识》的理解及我们的经验

    Institute of Scientific and Technical Information of China (English)

    郑成竹; 卓光鑽

    2012-01-01

    为了规范病态性肥胖症和肥胖症伴2型糖尿病的手术治疗,2011年3月,来自世界各地的外科专家聚集在美国佛罗里达州,讨论并制定了《国际袖状胃切除术专家组共识:基于12000例经验的最佳实践指南》,对袖状胃切除术的外科路径标准化方面作出了有益的尝试.上海第二军医大学长海医院微创外科结合开展病态性肥胖症并2型糖尿病手术治疗10多年的经验以及对上述《共识》的理解,对《共识》中提到的袖状胃切除术的学习曲线、术前准备、适应证与禁忌证、手术技术及并发症预防与处理、术后管理等方面谈了自己的体会.%An international symposium on the standard surgical treatment of morbid obesity and type 2 diabetes mellitus was held in Florida,USA on March,2011.An expert panel from all over the world attended the meeting.The expert panelists discussed and established International Sleeve Gastrectomy Expert Panel Consensus Statement:best practice guidelines based on experience of more than 12,000 cases,which made a very commendable attempt in standardized surgical pathway of sleeve gastrectomy.Based on clinical experience of over 10 years and the understanding of the consensus,this paper discusses the learning curve,preoperative preparation,indications/contraindications,surgical technique,management and prevention of complications,and postoperative management.

  13. Serum concentrations and subcutaneous adipose tissue mRNA expression of omentin in morbid obesity and type 2 diabetes mellitus: the effect of very-low-calorie diet, physical activity and laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Urbanová, M; Dostálová, I; Trachta, P; Drápalová, J; Kaválková, P; Haluzíková, D; Matoulek, M; Lacinová, Z; Mráz, M; Kasalický, M; Haluzík, M

    2014-01-01

    Omentin is a novel adipokine with insulin-sensitizing effects expressed predominantly in visceral fat. We investigated serum omentin levels and its mRNA expression in subcutaneous adipose tissue (SCAT) of 11 women with type 2 diabetes mellitus (T2DM), 37 obese non-diabetic women (OB) and 26 healthy lean women (C) before and after various weight loss interventions: 2-week very-low-calorie diet (VLCD), 3-month regular exercise and laparoscopic sleeve gastrectomy (LSG). At baseline, both T2DM and OB groups had decreased serum omentin concentrations compared with C group while omentin mRNA expression in SCAT did not significantly differ among the groups. Neither VLCD nor exercise significantly affected serum omentin concentrations and its mRNA expression in SCAT of OB or T2DM group. LSG significantly increased serum omentin levels in OB group. In contrast, omentin mRNA expression in SCAT was significantly reduced after LSG. Baseline fasting serum omentin levels in a combined group of the studied subjects (C, OB, T2DM) negatively correlated with BMI, CRP, insulin, LDL-cholesterol, triglycerides and leptin and were positively related to HDL-cholesterol. Reduced circulating omentin levels could play a role in the etiopathogenesis of obesity and T2DM. The increase in circulating omentin levels and the decrease in omentin mRNA expression in SCAT of obese women after LSG might contribute to surgery-induced metabolic improvements and sustained reduction of body weight.

  14. 袖状胃切除术与Roux-en-Y胃转流术治疗肥胖及2型糖尿病疗效的Meta分析%A META-ANALYSIS OF SLEEVE GASTRECTOMY VERSUS ROUX-EN-Y GASTRIC BYPASS FOR MORBID OBESITY AND DIABETES MELLITUS

    Institute of Scientific and Technical Information of China (English)

    颜朝阳; 颜振民; 张志; 尉建安; 孙少华; 张忠涛; 孟化

    2016-01-01

    Objective:To review the effect of sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass( RYGB) for the treatment of obesity and type 2 diabetes. Methods:Electronic literature search was performed on PubMed,EMBASE,Cochrane Library,CNKI and Wanfang database from inception to October 1 ,2014 . The following medical subject headings ( MeSH ) and keywords were used:“bariatric surgery”、“T2 DM”、“gastric bypass”、“sleeve gastrectomy”、“RCT”. Finally we got 9 literatures focused on the comparison of the effect of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of obesity and type 2 diabetes to review. Results:Among all the 9 included studies,a total of 713 cases were reported,including 315 patients in the sleeve gastrectomy group and 398 patients in the Roux-en-Y gastric bypass group. The results of the Meta analysis showed that there were no significant difference in the remission rate of T2DM(RR=0. 85,95%CI:0. 67 ~1. 09,P>0. 05),no significant difference in the percentage excess weight loss ( MD=0 . 29 , 95%CI:-6 . 51 ~7 . 10 , P>0 . 05 ) , no significant difference in the change of BMI(MD=-0. 32,95%CI:-1. 16~0. 51,P>0. 05). But in the incidence of complications,the sleeve gastrectomy showed significant advantage(RR=0. 55,95%CI:0. 33~0. 94,P0.05),术后多余体重降低百分比(MD=0.29,95%CI:-6.51~7.10,P>0.05)和术后体重指数(body mass index,BMI)变化(MD=-0.32,95%CI:-1.16~0.51,P>0.05)方面效果相当;在术后并发症方面,袖状胃切除术优于Roux-en-Y胃转流术(RR=0.55,95%CI:0.33~0.94,P<0.05)。结论:袖状胃切除术在对肥胖及2型糖尿病的治疗上可作为优选术式。

  15. Differential effects of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on appetite, circulating acyl-ghrelin, peptide YY3-36 and active GLP-1 levels in non-diabetic humans.

    Science.gov (United States)

    Yousseif, Ahmed; Emmanuel, Julian; Karra, Efthimia; Millet, Queensta; Elkalaawy, Mohamed; Jenkinson, Andrew D; Hashemi, Majid; Adamo, Marco; Finer, Nicholas; Fiennes, Alberic G; Withers, Dominic J; Batterham, Rachel L

    2014-02-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGBP) reduces appetite and induces significant and sustainable weight loss. Circulating gut hormones changes engendered by LRYGBP are implicated in mediating these beneficial effects. Laparoscopic sleeve gastrectomy (LSG) is advocated as an alternative to LRYGBP, with comparable short-term weight loss and metabolic outcomes. LRYGBP and LSG are anatomically distinct procedures causing differential entero-endocrine cell nutrient exposure and thus potentially different gut hormone changes. Studies reporting the comparative effects of LRYGBP and LSG on appetite and circulating gut hormones are controversial, with no data to date on the effects of LSG on circulating peptide YY3-36 (PYY3-36) levels, the specific PYY anorectic isoform. In this study, we prospectively investigated appetite and gut hormone changes in response to LRYGBP and LSG in adiposity-matched non-diabetic patients. Anthropometric indices, leptin, fasted and nutrient-stimulated acyl-ghrelin, active glucagon-like peptide-1 (GLP-1), PYY3-36 levels and appetite were determined pre-operatively and at 6 and 12 weeks post-operatively in obese, non-diabetic females, with ten undergoing LRYGBP and eight adiposity-matched females undergoing LSG. LRYGBP and LSG comparably reduced adiposity. LSG decreased fasting and post-prandial plasma acyl-ghrelin compared to pre-surgery and to LRYGBP. Nutrient-stimulated PYY3-36 and active GLP-1 concentrations increased post-operatively in both groups. However, LRYGBP induced greater, more sustained PYY3-36 and active GLP-1 increments compared to LSG. LRYGBP suppressed fasting hunger compared to LSG. A similar increase in post-prandial fullness was observed post-surgery following both procedures. LRYGBP and LSG produced comparable enhanced satiety and weight loss. However, LSG and LRYGBP differentially altered gut hormone profiles.

  16. Reported appetite, taste and smell changes following Roux-en-Y gastric bypass and sleeve gastrectomy: Effect of gender, type 2 diabetes and relationship to post-operative weight loss.

    Science.gov (United States)

    Makaronidis, Janine M; Neilson, Sabrina; Cheung, Wui-Hang; Tymoszuk, Urszula; Pucci, Andrea; Finer, Nicholas; Doyle, Jacqueline; Hashemi, Majid; Elkalaawy, Mohamed; Adamo, Marco; Jenkinson, Andrew; Batterham, Rachel L

    2016-12-01

    Reduced energy intake drives weight loss following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures. Post-operative changes in subjective appetite, taste, and smell and food preferences are reported and suggested to contribute to reduced energy intake. We aimed to investigate the prevalence of these changes following RYGB and SG and to evaluate their relationship with weight loss. 98 patients post-RYGB and 155 post-SG from a single bariatric centre were recruited to a cross-sectional study. Participants completed a questionnaire, previously utilised in post-operative bariatric patients, to assess the prevalence of post-operative food aversions and subjective changes in appetite, taste and smell. Anthropometric data were collected and percentage weight loss (%WL) was calculated. The relationship between food aversions, changes in appetite, taste and smell and %WL was assessed. The influence of time post-surgery, gender and type 2 diabetes (T2D) were evaluated. Following RYGB and SG the majority of patients reported food aversions (RYGB = 62%, SG = 59%), appetite changes (RYGB = 91%, SG = 91%) and taste changes (RYGB = 64%, SG = 59%). Smell changes were more common post-RYGB than post-SG (RYGB = 41%, SG = 28%, p = 0.039). No temporal effect was observed post-RYGB. In contrast, the prevalence of appetite changes decreased significantly with time following SG. Post-operative appetite changes associated with and predicted higher %WL post-SG but not post-RYGB. Taste changes associated with and predicted higher %WL following RYGB but not post-SG. There was no gender effect post-RYGB. Post-SG taste changes were less common in males (female = 65%, males = 40%, p = 0.008). T2D status in females did not influence post-operative subjective changes. However, in males with T2D, taste changes were less common post-SG than post-RYGB together with lower %WL (RYGB = 27.5 ± 2.7, SG = 14.6 ± 2.1, p = 0.003). Further research is

  17. 肥胖症患者袖状胃切除术的饮食护理与指导%Nutritional Care and Guidelines for Patients undergoing Laparoscopic Sleeve Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    潘莹莹; 谈锦艳; 侬宇琴; 陈雯; 李慧; 卓光鑽

    2014-01-01

    目的:探讨肥胖症患者袖状胃切除术的饮食护理及术后饮食指导,以保证患者围术期安全,提高手术疗效及患者术后生活质量。方法对2010年1月至2011年12月在第二军医大学长海医院微创外科实施腹腔镜下袖状胃切除术(laparo-scopic sleeve gastretomy,LSG)的82例肥胖症患者进行规范的围术期饮食护理及指导,术后定期进行营养跟踪教育。结果所有病例均顺利康复出院,并进行至少12个月的术后随访,体质量下降显著,相关并发症亦有不同程度改善。随访期内有15例患者出现脱发症状,其中1例较为严重,经饮食调整或药物治疗后均获不同程度缓解;所有病例均未见其他明显营养相关并发症。结论规范合理的饮食护理和指导是保证手术疗效、减少围术期并发症、避免术后营养相关并发症并提高患者生活质量的重要因素,值得临床推广应用。%Objective To discuss the measures of nutritional care and postoperative diet guidelines for the patients who undergo laparoscopic sleeve gastrectomy(LSG),and to ensure the safety in the perioperative period,getting the best operative efficacy and postoperative quality of life.Methods 82 patients underwent LSG surgery from department of minimally invasive surgery of Changhai Hospital during January 2010 to December 2011 were selected,normative nutritional care and guidelines were carried out,during the perioperative period,and a regular nutritional follow-up and tracking education were given after discharge. Results All the patients were fully recovered and discharged with 1 2 months of follow-up,with significant weight loss and less related complications.During this period,1 5 patients got hair loss,one of which was quite serious.All of them had been symptomatically improved in some degree respectively after dietary modification or medical treatment.All patients had no other significant nutritional-related complication. Conclusion

  18. Efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus: a Meta-analysis%胃袖状切除术与Roux-en-Y胃旁路术治疗2型糖尿病疗效的Meta分析

    Institute of Scientific and Technical Information of China (English)

    谢晓峰; 王琛; 李娜; 李倩; 张文亮; 李敏

    2013-01-01

    目的 系统评价胃袖状切除术与Roux-en-Y胃旁路术治疗2型糖尿病的疗效.方法 以减重手术、胃切除术、胃绕道术、胃旁路手术、胃转流术、胃袖状切除术、糖尿病、bariatric surgery、gastric bypass、sleeve gastrectomy、diabetes、T2DM等为关键词检索Cochrane library、PubMed、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库和万方数据库.检索时间为各数据库建库至2012年12月.最终纳入胃袖状切除术对比Roux-en-Y胃旁路术治疗2型糖尿病的相关文献,再由2名研究者分别独立提取数据并进行文献质量评价,用RevMan 5.1.2软件进行Meta分析.计数资料采用相对危险度(risk ratio,RR)或比值比(odds ratio,OR)分析统计,计量资料采用均数差(mean difference,MD)或标准差(standardmean difference,SMD)分析统计.采用I2对异质性进行定量分析.结果 共纳入符合标准的文献5篇,其中胃袖状切除术组164例,Roux-en-Y胃旁路术组184例.Meta分析结果显示:与胃袖状切除术比较,Roux-en-Y胃旁路术能更显著地提高患者糖尿病的缓解率(OR =0.48,95% CI:0.26 ~0.91,P<0.05),提高随访期间停止服药的比例(OR =0.37,95% CI:0.16 ~0.84,P <0.05),更有效降低糖化血红蛋白水平(MD=0.28,95%CI:0.14 ~0.43,P<0.05)和体质量(MD=-0.44,95% CI:-0.76 ~-0.13,P<0.05).胃袖状切除术与Roux-en-Y胃旁路术患者术后并发症发生率比较,差异无统计学意义(OR=1.81,95% CI:0.20~16.73,P>0.05).结论 Roux-en-Y胃旁路术较胃袖状切除术在治疗2型糖尿病的疗效方面具有一定的优势.%Objective To review the efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus.Methods The Cochrane library,PubMed,China Journal Full Text Database,Chinese Scientific Journal Full Text Database,Chinese Biomedical Literature Database and Wanfang Database were searched with key

  19. Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent

    Directory of Open Access Journals (Sweden)

    Albin Abraham

    2012-01-01

    Full Text Available Laparoscopic sleeve gastrectomy has been a recently developed technique for treating morbid obesity. Gagner and Patterson performed the first laparoscopic sleeve gastrectomy as part of a duodenal switch procedure at Mount Sinai Hospital in New York in 1999. Since then many surgeons and institutions have adopted this technique. One of the most dreaded complications of sleeve gastrectomy is a leak along the staple line. We present the case of a 23-year-old female with gastric sleeve leak managed successfully with a fully covered wall flex stent. Our aim is to examine the incidence, causes, classification, and presentation of gastric sleeve leaks and to evaluate the use of endoscopic stents in its management.

  20. Gastric Sleeve Surgery

    Science.gov (United States)

    ... A Week of Healthy Breakfasts Shyness Gastric Sleeve Surgery KidsHealth > For Teens > Gastric Sleeve Surgery Print A ... buying healthy food ) continue Preparing for Gastric Sleeve Surgery Preparing for this major operation takes months of ...

  1. The gastric sleeve: losing weight as fast as micronutrients?

    NARCIS (Netherlands)

    Aarts, E.O.; Janssen, I.M.; Berends, F.J.

    2011-01-01

    BACKGROUND: Recently, the laparoscopic sleeve gastrectomy (LSG) has become popular as a single-stage procedure for the treatment of morbid obesity and its co-morbidities. However, the incidence of micronutrient deficiencies after LSG have hardly been researched. METHODS: From January 2005 to October

  2. 肺复张对病态肥胖患者腹腔镜袖状胃切除术围术期肺功能的影响%Effects of alveolar recruitment maneuver on perioperative pulmonary function in morbidly obese patients undergoing laparoscopic sleeve gastrectomy

    Institute of Scientific and Technical Information of China (English)

    魏珂; 曹俊; 彭丽桦; 黎平; 闵苏

    2016-01-01

    Objective To evaluate the effect of alveolar recruitment maneuver on the perioperative pulmonary function in the morbidly obese patients undergoing laparoscopic sleeve gastrectomy.Methods Forty morbidly obese patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,with body mass index ≥ 40 kg/m2,scheduled for elective laparoscopic sleeve gastrectomy,were randomly divided into either control group (group C) or alveolar recruitment maneuver group (group R) using a random number table,with 20 patients in each group.Patients in group C were treated with volume-or pressure-controlled ventilation after creation of pneumoperitoneum,maintaining the peak inspiratory pressure (Ppeak) ≤ 30 cmH2O and partial pressure of end-tidal CO2 35-40 mmHg.Patients in group R received alveolar recruitment maneuver once every 30 min starting from creation of pneumoperitoneum until the end of surgery.Patients were transfered to post-anesthesia care unit (PACU) with endotracheal tube which was extubated when the unified extubation standard was achieved in PACU.The patients who stayed in PACU for 2 h showing no indications for extubation were transfered to intensive care unit for continuous ventilation support.Immediately after intubation,immediately after creation of pneumoperitoneum,at 30,60 and 90 min of pneumoperitoneum,and at the end of pneumoperitoneum,blood samples were collected from the radial artery for blood gas analysis.Immediately after intubation,immediately after creation of pneumoperitoneum,at 30,60 and 90 min of pneumoperitoneum,at the end of surgery,and immediately before discharge from PACU,Ppeak,plateau pressure (Peat),and dynamic lung compliance were recorded.The time for achieving extubation standard and time for achieving the standard for discharge from PACU were recorded.Patients were followed up until discharge,and the feeding time and duration of hospital stay were recorded.Results Compared with group C,PaO2 and

  3. 腹腔镜胃袖状切除术联合十二指肠空肠吻合术与腹腔镜Roux-en-Y胃旁路术治疗非肥胖型2型糖尿病的疗效比较%Comparison of the efficacies of laparoscopic sleeve gastrectomy with duodenojejunal bypass and laparoscopic Roux-en-Y gastric bypass in the treatment of patients with non-obese type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    梁辉; 管蔚; 刘欢; 曹庆; 苗毅

    2013-01-01

    RYGB组患者术后出现贫血、维生素缺乏、腹泻分别为0、0、2例和3、2、6例,两组比较,差异无统计学意义(x2=1.795,1.167,0.908,P>0.05).所有患者术后6个月BMI> 19 kg/m2.结论 胃袖状切除术+十二指肠空肠吻合术和Roux-en-Y胃旁路术对于非肥胖型2型糖尿病患者的治疗效果和术后相关并发症发生率相当.胃袖状切除术+十二指肠空肠吻合术对患者营养状况的干扰略低于Roux-en-Y胃旁路术.%Objective To investigate the efficacies of laparoscopic sleeve gastrectomy + duodenojejunal bypass (DJB) and laparoscopic gastric bypass in the treatment of patients with non-obese type 2 diabetes mellitus (T2DM).Methods The clinical data of 42 patients with type 2 diabetes mellitus and body mass index (BMI) < 30 kg/m2 received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2012 to June 2013 were retrospectively analyzed.Fifteen patients received laparoscopic sleeve gastrectomy + DJB (Sleeve + DJB group),and 27 received Roux-en-Y gastric bypass (RYGB group).The follow-up time for all the patients was more than 6 months.The decrease of BMI,complete remission of T2DM,decrease of fasting glycemia and glycosylated hemoglobin (HbAlc),postoperative nutritional condition and the incidence of complications of the 2 groups were compared.The measurement data were analyzed using the t test and the repeated measurement chi-square test.Results The operation time of the Sleeve + DJB group and the RYGB group were (137 ± 61)minutes and (89 ± 43) minutes,with significant difference between the 2 groups (t =6.158,P < 0.05).No mortality and hemorrhage,bowel obstruction and anastomotic stenosis were detected.One patient was complicated with bile leakage in the Sleeve + DJB group,and was cured by conservative treatment 5 days later.The levels of fasting glucose before operation and at postoperative month 1,3,6 were (8.9 ± 0.7) mmol/L,(5.8 ± 1.3) mmoL/L,(5.6 ±1

  4. Application value of the clinical curative effect for laparoscopic sleeve gastrectomy with duodeno- jejunal bypass to treat non-obese type 2 diabetes%袖状胃切除联合十二指肠-空肠转流术在非肥胖型2型糖尿病中的应用价值

    Institute of Scientific and Technical Information of China (English)

    殷骏; 毛忠琦; 徐露; 朱政; 陈昕; 周晓俊; 钱海鑫

    2015-01-01

    Objective To explore the clinical effectiveness and safety of laparoscopic sleeve gastrectomy-duodenojejunal bypass (LSG+DJB) in the non-obese diabetes patients.Methods The data of 12 non-obese patients with type 2 diabetes mellitus who underwent LSG+DJB from June 2012 to December 2013 were analyzed, including the length of hospitalization, operative time, blood loss, operative related complications and weight, BMI, waist circumference, fasting plasma glucose (FPG), oral glucose tolerance test, HbA1c, blood lipids and the changing of diabetes complications at pre and postoperative time of 1,3,6 and 12 months.Results All the procedures were preformed smoothly without perioperative death. Esophageal reflux symptoms such as heartburn happened to one case after the procedure, and released after conservative treatment. The FPG, HbA1c, HOMA-IR, C-peptide, weight, BMI, waist circumference, serum triglyceride (TG), low density lipoprotein cholesterol (LDL-C) of the patients were declined significantly after the procedure (P<0.05). One year after the procedures, 9 cases stopped taking medicine because of the remission of T2DM, including 3 cases completely cured (HbA1c<6.0%) and 6 cases controlled (HbA1c<7.0%), andthe other 3 cases decreased hypoglycemic agent.Conclusions LSG+DJB performed safely in non-obese patients with type 2 diabetes with the good effectiveness of controlling weights, improving blood glucose, blood lipid and related complications. The short-term effectiveness is good, but the long-term effectiveness remains further observation.%目的探讨腹腔镜袖状胃切除联合十二指肠-空肠转流术(laparoscopic sleeve gastrectomy-duodenojejunal bypass,LSG-DJB)治疗非肥胖型2型糖尿病的疗效。方法收集苏州大学附属第一医院2012年6月至2013年12月应用LSG-DJB治疗的12例非肥胖型(BMI<30 kg/m2)2型糖尿病患者的临床资料,记录患者的住院时间,手术时间,手术失血量,手术相关并

  5. Staple-line leak after sleve gastrectomy in obese patients:A hot topic in bariatric surgery

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Laparoscopic sleeve gastrectomy is a surgical procedurethat is being increasingly performed on obese patients.Among its complications, leaks are the most seriousand life threatening. The placement of esophageal,covered, self-expandable metal stents in these caseshas been performed by many authors but reports on theoutcome of this procedure are limited and the technicalaspects are not well defined. Stent migration is the maincomplication of the procedure and poses a challenge tothe surgeon, with a limited number of options. Here weevaluate the technical and clinical outcome of a new,dedicated, self-expanding metal stent, comparing theadvantages of this stent to those traditionally used totreat staple-line leak after sleeve gastrectomy. Whilepublished data are limited, they seem support the use ofthis kind of new stent as the best option for the stentingtreatment of a staple-line leak after sleeve gastrectomy,over other kinds of stents. Further studies based onlarger series are needed to better evaluate patientoutcome.

  6. Single port access sleeve gastrectomy: Is it reasonable?

    Directory of Open Access Journals (Sweden)

    Ramon Vilallonga

    2011-01-01

    Full Text Available This short letter is in response to the article published in your publication about single-incision laparoscopic bariatric surgery, by Chih-Kun Huang. We want to focus on the technical aspects.

  7. Wernicke’s encephalopathy after sleeve gastrectomy: Literature review

    Directory of Open Access Journals (Sweden)

    Fernando Pardo-Aranda

    2016-01-01

    Conclusion: Nutritional deficiencies after restrictive procedures are uncommon but easily preventable and can result in life threatening. With the upswing of bariatric surgery, surgeons and emergency physicians should be able to diagnose and treat those complications. Prophylactic thiamine should be administered to patients with predisposing factors.

  8. 腹腔镜管状胃胃切除术治疗肥胖症合并2型糖尿病患者的围手术期护理%Perioperative nursing of laparoscopic sleeve gastrectomy for obesity patients with type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    刘蕾; 杨筱萃; 李慧; 潘莹莹; 卓光鑽; 谈锦艳

    2012-01-01

    目的:探讨腹腔镜下管状胃胃切除术(LSG)治疗肥胖症合并2型糖尿病(diabetes mellitus,2型DM)患者的围手术期护理措施,以提高护理质量.方法:选择19例行LSG肥胖症合并2型DM患者,术前加强心理疏导,讲解肥胖及2型DM危害,科普手术知识及风险-效益比;术后加强导管护理及并发症观察,注意饮食和运动指导,强调严格遵食谱饮食及定期随访的重要性.总结LSG治疗肥胖症合并2型DM的围术期护理流程.结果:本组19例患者手术均经腹腔镜完成,无中转开腹,术后均顺利康复出院,围手术期无手术及护理并发症发生.结论:有效的围手术期护理措施是保障手术成功的重要因素,应针对肥胖症合并2型DM患者的疾病及心理特点,采取有针对性的护理措施,促进患者早日康复,提高患者的生存质量.%Objective:To investigate the effective perioperative nursing measures of laparoscopic sleeve gastrectomy (LSG) for type 2 diabetes mellitus. Methods; 19 patients with obesity combined with type 2 diabetes mellitus were included. Before LSG procedure,all the patients underwent the psychothera-py, got a better understanding of the dangers of obesity and type 2 diabetes mellitus and informed of the procedure and cost - effectiveness. After the proce-dure, catheter care was performed and complications were closed observed. Patients were guided to undertake some exercise and watch their diet. All patients were aware of the importance of sticking to rigid diet and regularly follow - up. On that basis, the procedures of perioperative nursing for obesity combined with type 2 diabetes mellitus were concluded. Results:All cases were successfully operated by laparoscope. There was no conversion. All the patients recov-ered uneventful and were discharged. No procedure or nursing - related complication was seen during the perioperative period. Conclusion:The effective perioperative nursing was a most important factor for a

  9. Aspectos técnicos da interposição ileal com gastrectomia vertical como possível opção ao tratamento do diabetes mellitus tipo 2 Technical aspects of ileal interposition with sleeve gastrectomy as a possible option for the treatment of type 2

    Directory of Open Access Journals (Sweden)

    Aureo Ludovico de Paula

    2010-06-01

    mortalidade, factível cirurgicamente pela via laparoscópica e passível de ser ofertada como opção operatória ao tratamento da diabetes mellitus tipo 2.INTRODUCTION: There is an evidence that the best results in terms of resolution of diabetes in morbidly obese patients are achieved with bilio-pancreatic bypass, especially the duodenal switch. These operations are characterized by partial gastrectomy and the rapid transit of food into the distal ileum through derivation of a significant segment of small intestine. The idea of performing the technique presented here was based on these principles. METHOD: The procedures are usually performed laparoscopically, after establishment of a pneumoperitoneum at 12-15 mmHg and introduction of six trocars. The patient is initially positioned in 30° reverse Trendelenburg with the surgeon on the right side of the patient. The sleeve gastrectomy is performed using the anatomical distal trifurcation of the anterior vagus nerve as a reference. The devascularization of the greater curvature is performed and extends to the oesophagogastric junction. With an intra-gastric calibration tube of 20 mm positioned along the lesser curvature, gastric resection starts at the proximal antrum with linear stapler up to oesophagogastric angle. An invaginating running suture is also performed. To perform the ileal interposition in the proximal jejunum, it is divided 20-30 cm distally with a 45-mm linear stapler. The cecum is identified and the distal ileum transected 30cm proximal to the ileocecal valve. A 170 to 200 cm of ileum was measured proximally along the anti-mesenteric border using a 10-cm marked atraumatic grasper, and transected with a 45-mm linear stapler. This segment of ileum is interposed in an isoperistaltic way into the proximal jejunum, previously divided. Next are perform three side-to-side enteroanastomosis. The first enteroanastomosis is the ileo-ileostomy, then the jejuno-ileostomy and finally, the ileo-jejunostomy. All three

  10. ENDOSCOPIC SLEEVE GASTROPLASTY - MINIMALLY INVASIVE THERAPY FOR PRIMARY OBESITY TREATMENT

    Science.gov (United States)

    GALVÃO-NETO, Manoel dos Passos; GRECCO, Eduardo; de SOUZA, Thiago Ferreira; de QUADROS, Luiz Gustavo; SILVA, Lyz Bezerra; CAMPOS, Josemberg Marins

    2016-01-01

    ABSTRACT Background: Less invasive and complex procedures have been developed to treat obesity. The successful use of Endoscopic Sleeve Gastroplasty using OverStitch(r) (Apollo Endosurgery, Austin, Texas, USA) has been reported in the literature. Aim: Present technical details of the procedure and its surgical/ endoscopic preliminary outcome. Method: The device was used to perform plications along the greater curvature of the stomach, creating a tubulization similar to a sleeve gastrectomy. Result: A male patient with a BMI of 35.17 kg/m2 underwent the procedure, with successful achievement of four plications, and preservation of gastric fundus. The procedure was successfully performed in 50 minutes, time without bleeding or other complications. The patient presented mild abdominal pain and good acceptance of liquid diet. Conclusions: The endoscopic gastroplasty procedure was safe, with acceptable technical viability, short in duration and without early complications. PMID:27683786

  11. Laparoscopic sleeve gastrectomy with duodenal-jejunal bypass for the treatment of type 2 diabetes mellitus%腹腔镜胃袖状切除联合十二指肠空肠转流术治疗2型糖尿病

    Institute of Scientific and Technical Information of China (English)

    杨雁灵; 窦科峰; 陶开山; 丁睿

    2015-01-01

    Objective To investigate the clinical effects of laparoscopic sleeve gastrectomy with duodenaljejunal bypass (LSG + DJB) for the treatment of type 2 diabetes mellitus.Methods The clinical data of 17 patients with type 2 diabetes mellitus who underwent LSG + DJB at the Xijing Hospital of the Fourth Military Medical University from March 2013 to February 2014 were retrospectively analyzed.The fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin (HbA1c) and body mass index (BMI) in 17 patients before operation were (9.2 ± 0.6) mmol/L,(14.4 ± 2.2) mmol/L,8.3% ± 1.2% and (29.4 ± 2.2) kg/m2,respectively.All the patients received LSG + DJB and were followed up by outpatient examination up to March 2015.The pre-and post-operative 12-month fasting blood glucose,postprandial 2-hour blood glucose,HbA1 c and BMI in 17 patients were compared.Measurement data with normal distribution were presented as-x ± s and analyzed by the t test.Results All the 17 patients received successful laparoscopic LSG + DJB without conversion to open surgery.The operation time,volume of intraoperative blood loss and recovery time of postoperative gastrointestinal function were (141 ±53)minutes,40 mL and 2.5 days.Of 3 patients with postoperative complications,1 patient with anastomotic leakage at postoperative day 5 received reoperation by laparoscopic Roux-en-Y gastric bypass,1 patient with digestive tract obstruction at postoperative day 10 released obstruction by reoperation and 1 patient with left subphrenic abscess and leakage at the upper of the stomach at postoperative week 2 was cured by the symptomatic treatment.The duration of hospital stay was 5.2 days.All the patients were followed up for a median time of 16 months (range,13-24 months).The postoperative 12-month fasting blood glucose,postprandial 2-hour blood glucose,HbA1c and BMI in 17 patients were (5.5 ± 0.7)mmol/L,(8.8 ± 1.7)mmol/L,5.1% ± 0.7% and (24.7 ± 2.3)kg/m2,which were significantly

  12. Improvement of islet β-cell function after sleeve gastrectomy with ileal interposition duodenojejunal bypass in non-obese type 2 diabetes mellitus%非肥胖性2型糖尿病患者袖状胃切除间置回肠的十二指肠空肠旁路手术后胰岛β细胞功能的改善

    Institute of Scientific and Technical Information of China (English)

    杨映弘; 颜璟; 吴艳军; 蔺原; 岳晓林

    2014-01-01

    目的 探讨袖状胃切除间置回肠的十二指肠空肠旁路手术对非肥胖性2型糖尿病患者胰岛β细胞功能的改善作用.方法 回顾性分析2009年3月至2011年10月间在四川省攀枝花市中心医院接受袖状胃切除间置回肠的十二指肠空肠旁路手术的54例非肥胖型2型糖尿病患者的临床资料,包括术前及术后1、3、6、12、24月进行口服葡萄糖耐量试验结果和空腹血糖、糖化血红蛋白(HbA1c)及空腹胰岛素等检测结果,并计算胰岛素抵抗指数(HOMA-IR)、稳态模型β细胞功能(HOMA-β)、早期胰岛素分泌指数(△I30/△G30)及胰岛素曲线下面积(AUCINS).结果 术后24月,HbA1c由术前的(8.2±0.8)%降至(6.3±0.1)%,空腹血糖由(9.2±0.6) mmol/L降至(5.9±0.5)mmol/L,空腹胰岛素由(9.7±1.5) mIU/L降至(6.2±0.7) mIU/L,差异均有统计学意义(均P<0.05);同时,HOMA-IR较术前明显下降(0.8±0.3比2.1±0.6,P<0.05),HOMA-β明显升高(56.3±12.8比28.4±9.2,P<0.05),△I30/△G30明显升高(1.8±0.7比0.8±0.2,P<0.05),而AUCINS在术后1月和3月时较术前下降,但术后6、12和24月时较术前上升(P<0.05).相关分析结果显示,HbA1c与HOMA-β(r=-0.628,P<0.01)、△I30/△G30(r=-0.571,P<0.01)和AUCINS(r=-0.606,P<0.01)呈显著负相关,与HOMA-IR呈显著正相关(r=0.784,P<0.01).结论 袖状胃切除间置回肠的十二指肠空肠旁路手术能改善胰岛β细胞功能,从而达到治疗糖尿病的作用.%Objective To investigate the improvement of islet β-cell function after sleeve gastrectomy with ileal interposition duodeaojejunal bypass operation in non-obese type 2 diabetes mellitus.Methods Clinical data of 54 non-obese type 2 diabetes mellitus cases undergoing sleeve gastrectomy with ileal interposition duodenojejunal bypass operation in our hospital from March 2009 to October 2011 were retrospectively analyzed.Fasting glucose,glycosylated hemoglobin (HbA1c),fasting insulin,body mass index (BMI

  13. Tappet sleeve lubrication

    Energy Technology Data Exchange (ETDEWEB)

    Kapp, G.E.

    1988-05-24

    In combination, this patent describes a non-ferrous body containing a lubricant distribution gallery, a sleeve of material diverse from that of the body and cast within the non-ferrous material thereof to form internally a bore for the reciprocating movement of a lubricated member, and an oil feed passage from the gallery through the non-ferrous material extension to the bore. The feed passage is wholly within the non-ferrous material and free of any intersection with the diverse material interface, whereby any leakage of pressure oil directly from the feed passage through the interface is avoided.

  14. Bursectomy at radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Cuneyt; Kayaalp

    2015-01-01

    Radical gastrectomy with extended lymph node dissec tion and prophylactic resection of the omentum, peri toneum over the posterior lesser sac, pancreas and/o spleen was advocated at the beginning of the 1960 s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursaomentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended.

  15. Gastric Band Removal in Revisional Bariatric Surgery, One-Step Versus Two-Step: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Dang, Jerry T; Switzer, Noah J; Wu, Jeremy; Gill, Richdeep S; Shi, Xinzhe; Thereaux, Jérémie; Birch, Daniel W; de Gara, Christopher; Karmali, Shahzeer

    2016-04-01

    We aimed to systematically review the literature comparing the safety of one-step versus two-step revisional bariatric surgery from laparoscopic adjustable gastric banding (LAGB) to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). There is debate on the safety of removing the gastric band and performing revisional surgery immediately or in a delayed, two-step fashion due to potential higher complications in one-step revisions. A systematic and comprehensive search of the literature was conducted. Included studies directly compared one-step and two-step revisional surgery. Eleven studies were included with 1370 patients. Meta-analysis found comparable rates of complications, morbidity, and mortality between one-step and two-step revisions for both RYGB and SG groups. This suggests that immediate or delayed revisional bariatric surgeries are both safe options for LAGB revisions.

  16. Post-gastrectomy spleen enlargement and esophageal varices: Distal vs total gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Takatsugu; Oida; Kenji; Mimatsu; Hisao; Kano; Atsushi; Kawasaki; Youichi; Kuboi; Nobutada; Fukino; Sadao; Amano

    2010-01-01

    AIM: To study the relationship between platelet count-to-spleen diameter ratio and post-gastrectomy esopha-geal varices (EVs) development in patients without liver cirrhosis or hepatitis. METHODS: We retrospectively studied 92 patients who underwent gastrectomy. They were divided into 2 groups on the basis of the surgical treatment: the distal gastrectomy (DG) group and total gastrectomy (TG) group. The incidence of EVs was determined and postoperative platelet counts, spleen diameters, and platelet count-t...

  17. Liver transplantation and sleeve gastrectomy in the medically complicated obese: New challenges on the horizon

    Institute of Scientific and Technical Information of China (English)

    Diego; C; Reino; Keri; E; Weigle; Erik; P; Dutson; Adam; S; Bodzin; Keri; E; Lunsford; Ronald; W; Busuttil

    2015-01-01

    In the last 30 years, operative, technical and medical advances have made liver transplantation(LT) a lifesaving therapy that is used worldwide today. Global industrialization has been a contributor to morbid obesity and this has brought about the metabolic syndrome along with many downstream complications of such. Non-alcoholic steatohepatitis(NASH) has become a recognized hepatic manifestation of the metabolic syndrome and NASH cirrhosis is predicted to be the primary indication for LT in the United States by 2025. Several case series and database reviews have begun analyzing the efficacy of weight reduction surgery in the LT recipient. These data have reasonably demonstrated that weight reduction surgery in the LT recipient is a feasible endeavor. However, several questions have been raised regarding the type of weight reduction surgery, timing of surgery in relation to LT, patient and allograft survival and post-LT maintenance of weight loss to name a few. We look forward to a time when weight reduction surgery will work to improve the technical conduct of LT, improve perioperative benchmarks such as blood transfusions, intensive care unit length of stay and help to prevent recurrence of NASH cirrhosis in the medically complicated obese patient. In the meantime, well-designed prospective clinical trials that focus on the issues highlighted will help guide us in the care of these complicated patients who will soon account for the majority of the patients in our clinics.

  18. Liver transplantation and sleeve gastrectomy in the medically complicated obese: New challenges on the horizon

    OpenAIRE

    Reino, DC; Weigle, KE; Bodzin, AS; Lunsford, KE; Busuttil, RW; Dutson, EP

    2015-01-01

    © 2015 Baishideng Publishing Group Inc. In the last 30 years, operative, technical and medical advances have made liver transplantation (LT) a lifesaving therapy that is used worldwide today. Global industrialization has been a contributor to morbid obesity and this has brought about the metabolic syndrome along with many downstream complications of such. Non-alcoholic steatohepatitis (NASH) has become a recognized hepatic manifestation of the metabolic syndrome and NASH cirrhosis is predicte...

  19. Liver transplantation and sleeve gastrectomy in the medically complicated obese: New challenges on the horizon.

    Science.gov (United States)

    Reino, Diego C; Weigle, Keri E; Dutson, Erik P; Bodzin, Adam S; Lunsford, Keri E; Busuttil, Ronald W

    2015-09-28

    In the last 30 years, operative, technical and medical advances have made liver transplantation (LT) a life-saving therapy that is used worldwide today. Global industrialization has been a contributor to morbid obesity and this has brought about the metabolic syndrome along with many downstream complications of such. Non-alcoholic steatohepatitis (NASH) has become a recognized hepatic manifestation of the metabolic syndrome and NASH cirrhosis is predicted to be the primary indication for LT in the United States by 2025. Several case series and database reviews have begun analyzing the efficacy of weight reduction surgery in the LT recipient. These data have reasonably demonstrated that weight reduction surgery in the LT recipient is a feasible endeavor. However, several questions have been raised regarding the type of weight reduction surgery, timing of surgery in relation to LT, patient and allograft survival and post-LT maintenance of weight loss to name a few. We look forward to a time when weight reduction surgery will work to improve the technical conduct of LT, improve perioperative benchmarks such as blood transfusions, intensive care unit length of stay and help to prevent recurrence of NASH cirrhosis in the medically complicated obese patient. In the meantime, well-designed prospective clinical trials that focus on the issues highlighted will help guide us in the care of these complicated patients who will soon account for the majority of the patients in our clinics.

  20. Resolution of type 2 diabetes and prediabetes following laparoscopic sleeve gastrectomy: medium term results.

    Science.gov (United States)

    Romero Lluch, Ana R; Martínez-Ortega, Antonio J; Socas-Macías, María; Jiménez-Varo, Ignacio; Pereira-Cunill, José L; Serrano-Aguayo, Pilar; Morales-Conde, Salvador; García-Luna, Pedro P

    2014-11-15

    Objetivos: Evaluar la efectividad de la gastroplastia tubular laparoscópica (GTL) en la resolución de la diabetes tipo 2 (DM2), de la prediabetes (PDM) y de otras comorbilidades en pacientes obesos. Material y métodos: Estudio observacional retrospectivo. Se incluyeron a los pacientes con DM2 (n= 36) o PDM (n= 44) que fueron sometidos a GTL en nuestro hospital entre 2009 y 2012. Se consideró criterio de PDM presentar HbA1c entre 5.7-6.4% en al menos dos ocasiones. Periodo de seguimiento entre 1-4 años (media 17.5 meses). Como criterio de resolución de la DM2 se consideró presentar HbA1c.

  1. Robotic-assisted double-sleeve lobectomy

    Science.gov (United States)

    Qiu, Tong; Zhao, Yandong; Xuan, Yunpeng

    2017-01-01

    Double-sleeve lobectomy, which includes bronchoplasty and pulmonary arterial angioplasty, is required for certain cases of central-type lung cancer. It is usually done by open surgery or video-assisted thoracoscopic surgery (VATS). In recently, da Vinci system and robotic surgery have been applied in such complicated cases. Here we describe the details associated with robotic-assisted double-sleeve lobectomy. PMID:28203433

  2. Sleeve Muscle Actuator: Concept and Prototype Demonstration

    Institute of Scientific and Technical Information of China (English)

    Tad Driver; Xiangrong Shen

    2013-01-01

    This paper presents the concept and prototype demonstration results of a new sleeve muscle actuator,which provides a significantly improved performance through a fundamental structural change to the traditional pneumatic muscle.Specifically,the sleeve muscle incorporates a cylindrical insert to the center of the pneumatic muscle,and thus eliminates the central portion of the intemal volume.Through the analysis of the actuation mechanism,it is shown that the sleeve muscle is able to provide a consistent increase of force capacity over the entire range of motion.Furthermore,the sleeve muscle provides a significant energy saving effect,as a result of the reduced internal volume as well as the enhance force capacity.To demonstrate this new concept,a sleeve muscle prototype was designed and fabricated.Experiments conducted on the prototype verified the improvement in the force capacity and demonstrated a significant energy saving effect (20%-37%).Finally,as the future work on this new concept,the paper presents a new robotic elbow design actuated with the proposed sleeve muscle.This unique design is expected to provide a highly compact and powerful actuation approach for robotic systems.

  3. Negative pressures during swing phase in below-knee prostheses with rubber sleeve suspension.

    Science.gov (United States)

    Chino, N; Pearson, J R; Cockrell, J L; Mikishko, H A; Koepke, G H

    1975-01-01

    Negative pressures in the small space between the distal stump and the below-knee prosthetic socket were measured during swing phase for a series of nine subjects. A molded rubber sleeve connecting the prosthesis and the thigh was found to enhance this effect so that suction suspension occurred during the entire swing phase. Deterioration of the suction occurred when the sleeve was intentionally pierced, and when other suspensions such as a suprapatellar cuff or thigh band were tested. The findings indicate that the total-contact socket, gel liner and elastic sleeve combine to create suction in the below-knee socket which improves overall comfort and function for the patient in using the prosthesis.

  4. Downhole tool with replaceable tool sleeve sections

    Energy Technology Data Exchange (ETDEWEB)

    Case, W. A.

    1985-10-29

    A downhole tool for insertion in a drill stem includes elongated cylindrical half sleeve tool sections adapted to be non-rotatably supported on an elongated cylindrical body. The tool sections are mountable on and removable from the body without disconnecting either end of the tool from a drill stem. The half sleeve tool sections are provided with tapered axially extending flanges on their opposite ends which fit in corresponding tapered recesses formed on the tool body and the tool sections are retained on the body by a locknut threadedly engaged with the body and engageable with an axially movable retaining collar. The tool sections may be drivably engaged with axial keys formed on the body or the tool sections may be formed with flat surfaces on the sleeve inner sides cooperable with complementary flat surfaces formed on a reduced diameter portion of the body around which the tool sections are mounted.

  5. Statistical analysis of friction sleeve length effects on soil classification

    Science.gov (United States)

    Saussus, D. R.; Frost, J. D.; Dejong, J. T.

    2004-10-01

    The cone penetration test (CPT) provides profiles of the tip resistance, sleeve friction, and pore water pressure encountered while penetrating the subsurface. These parameters are used either directly or indirectly to classify the soil types present and to obtain geotechnical design parameters. However, fundamental discrepancies exist in the manner by which these parameters are measured. This paper describes the results of a study that shows the sleeve friction measurement introduces unnecessary redundancy due to the length of the standard friction sleeve compared to the measurement increment. Further, the high sleeve length to measurement increment ratio results in filtering and smoothing of the friction data, thereby causing the variability of the friction between the soil and the cone sleeve to be underestimated. The importance of understanding the role of the sleeve length on measurements is demonstrated using synthetically generated friction profiles and estimating the profiles that would be measured using sleeves of different lengths. Differences in how the soils are classified as a function of the sleeve length used to obtain each profile are illustrated. Solutions are presented to validate the synthetic sleeve friction profiles, to demonstrate the filtering and smoothing effects of the friction sleeve on the data, and to explain the implications of the sleeve length on soil classification. Copyright

  6. Performance of Grouted Splice Sleeve Connector under Tensile Load

    Directory of Open Access Journals (Sweden)

    A. Alias

    2016-05-01

    Full Text Available The grouted splice sleeve connector system takes advantage of the bond-slip resistance of the grout and the mechanical gripping of reinforcement bars to provide resistance to tensile force. In this system, grout acts as a load-transferring medium and bonding material between the bars and sleeve. This study adopted the end-to-end rebars connection method to investigate the effect of development length and sleeve diameter on the bonding performance of the sleeve connector. The end-to-end method refers to the condition where reinforcement bars are inserted into the sleeve from both ends and meet at the centre before grout is filled. Eight specimens of grouted splice sleeve connector were tested under tensile load to determine their performance. The sleeve connector was designed using 5 mm thick circular hollow section (CHS steel pipe and consisted of one external and two internal sleeves. The tensile test results show that connectors with a smaller external and internal sleeve diameter appear to provide better bonding performance. Three types of failure were observed in this research, which are bar fracture (outside the sleeve, bar pullout, and internal sleeve pullout. With reference to these failure types, the development length of 200 mm is the optimum value due to its bar fracture type, which indicates that the tensile capacity of the connector is higher than the reinforcement bar. It is found that the performance of the grouted splice sleeve connector is influenced by the development length of the reinforcement bar and the diameter of the sleeve.

  7. Hiatal Hernia as a Total Gastrectomy Complication

    Directory of Open Access Journals (Sweden)

    Bruna do Nascimento Santos

    2016-02-01

    Full Text Available Introduction: According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy. Case Report: A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery. Conclusion: Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication.

  8. VATS right upper lobe bronchial sleeve resection

    Science.gov (United States)

    Ma, Qianli

    2016-01-01

    Background The aim of this study is to discuss video-assisted thoracic surgery (VATS) sleeve bronchial lobectomy when handling the locally advanced central lung cancer (involving the trachea and/or main bronchus). Methods A 2.5 cm × 1.0 cm mass was found in the right upper lobe. Bronchoscopy demonstrated the tumor obstructing the right upper lobe bronchus and involved the right main bronchus and bronchus intermedius. Interrupted sutures were chosen for bronchial anastomosis. Bronchial membrane was sutured first, and then circumference end-to-end anastomoses were carried out using 3-0 absorbable sutures. Results There were no complications and the patient was discharged 8 days postoperatively. Conclusions The third intercostal space of the anterior axillary line was suggested for right upper lobe bronchial sleeve resection. This incision can reduce the distance and angle between the anastomosis to the incision, and facilitate anastomosis. This approach can also prevent operator from fatigue for keeping one posture for a long time. Clearance of the mediastinal lymph nodes before cutting the bronchus was helpful for exposing the right main bronchus, the upper lobe bronchus and bronchus intermedius satisfied. And this option would avoid pulling bronchial anastomosis during mediastinal lymph nodes clearance. Interrupted suture was safe and effective for VATS bronchial anastomosis. PMID:27621889

  9. Food intake and nutritional status after gastrectomy

    DEFF Research Database (Denmark)

    Bisballe, S; Buus, S; Lund, B

    1986-01-01

    Food intake and nutritional status was studied in 67 patients, who had had a gastrectomy 2-30 years earlier, and in a randomly selected, matched group of healthy persons. The gastrectomized patients weighed less than the control persons (women 56.4 +/- 9.5 vs 61.4 +/- 6.9 kg; P less than 0.05; men.......01). The serum concentration of alkaline phosphatase was raised and the concentration of calcium, phosphorus and 25-hydroxycholecalciferol reduced in the gastrectomized group. None of these results could be explained from the nutritional study as both the intake of energy and protein and the intake of calcium...

  10. [Survival after gastrectomy for cancer. 209 cases].

    Science.gov (United States)

    Le Treut, Y P; Capobianco, C; Botti, G; Christophe, M; Lebreuil, G; Bricot, R

    1992-09-26

    The long-term results of 209 gastrectomies performed for adenocarcinoma, including 117 which were prospectively collected, are presented. Resection was curative in 154 cases (73.6 percent). The TNM distribution of the tumours was: stage I (TxNOMO) 75 cases, stage II (TxN1MO) 46 cases, stage III (TxN2MO) 33 cases and stage IV (TxNxM1) 55 cases. Lymph node involvement was more frequent in the prospective than in the retrospective study. With a more than 5 years' follow-up of 80 percent of the patients operated upon, the actuarial survival rate at 5 years (operative mortality included) was 38 percent for all lesions, 52 percent for curative resection and 2 percent for palliative resection. Following curative resection, the survival rates for tumours of the upper, middle and lower thirds of the stomach were 40, 60 and 55 percent respectively. These rates were 60 percent for stage I tumours, 54 percent for stage II tumours and 25 percent for stage III tumours. The results obtained in this series, where most of the curative gastrectomies included excision of N1 and N2 lymph nodes, show that lymph node involvement has no significant importance for the prognosis when it is proximal (N1) and is not incompatible with prolonged survival when it is pedicular (N2).

  11. Function-preserving gastrectomy for gastric cancer in Japan

    Science.gov (United States)

    Nomura, Eiji; Okajima, Kunio

    2016-01-01

    Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to function-preserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer (EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements: (1) reduction of the extent of gastrectomy; (2) preservation of the pylorus; and (3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy

  12. Laparoscopic sleeve gastrectomy using a synthetic bioabsorbable staple line reinforcement material: Post-operative complications and 6 year outcomes

    Directory of Open Access Journals (Sweden)

    Mahdi Saleh

    2016-09-01

    Conclusion: The synthetic bioabsorbable reinforcement material shows no staple line leaks making it safe to use. LSG as a procedure had a high resolution of obesity-related comorbidities as well as sustainable long-term weight loss.

  13. Uniportal video-assisted thoracoscopic bronchoplastic and carinal sleeve procedures.

    Science.gov (United States)

    Gonzalez-Rivas, Diego; Yang, Yang; Sekhniaidze, Dmitrii; Stupnik, Tomaz; Fernandez, Ricardo; Lei, Jiang; Zhu, Yuming; Jiang, Gening

    2016-03-01

    Despite of the recent advanced with the video-assisted thoracoscopic surgery (VATS), the most common approach for bronchial and carinal resection is still the open surgery. The technical difficulties, the steep learning curve and the concerns about performing an oncologic and safe reconstruction in advanced cases, are the main reasons for the low adoption of VATS for sleeve resections. Most of the authors use 3-4 incisions for thoracoscopic sleeve procedures. However these surgical techniques can be performed by a single incision approach by skilled uniportal VATS surgeons. The improvements of the surgical instruments, high definition cameras and recent 3D systems have greatly contributed to facilitate the adoption of uniportal VATS techniques for sleeve procedures. In this article we describe the technique of thoracoscopic bronchial sleeve, bronchovascular and carinal resections through a single incision approach.

  14. Robot-assisted laparoscopic gastrectomy for gastric cancer

    Science.gov (United States)

    Caruso, Stefano; Franceschini, Franco; Patriti, Alberto; Roviello, Franco; Annecchiarico, Mario; Ceccarelli, Graziano; Coratti, Andrea

    2017-01-01

    Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer. PMID:28101302

  15. Incidence and clinical features of endoscopic ulcers developing after gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Woo Chul Chung; Eun Jung Jeon; Kang-Moon Lee; Chang Nyol Paik; Sung Hoon Jung; Jung Hwan Oh; Ji Hyun Kim

    2012-01-01

    AIM:To determine the precise incidence and clinical features of endoscopic ulcers following gastrectomy.METHODS:A consecutive series of patients who underwent endoscopic examination following gastrectomy between 2005 and 2010 was retrospectively analyzed.A total of 78 patients with endoscopic ulcers and 759 without ulcers following gastrectomy were enrolled.We analyzed differences in patient age,sex,size of the lesions,method of operation,indications for gastric resection,and infection rates of Helicobacter pylori (H.pylori)between the nonulcer and ulcer groups.RESULTS:The incidence of endoscopic ulcers after gastrectomy was 9.3% and that of marginal ulcers was 8.6%.Ulcers were more common in patients with Billroth Ⅱ anastomosis and pre-existing conditions for peptic ulcer disease (PUD).Infection rates of H.pyloridid not differ significantly between the two groups.The patients who underwent operations to treat PUD had lower initial levels of hemoglobin and higher rates of hospital admission.CONCLUSION:H.pylori was not an important factor in ulcerogenesis following gastrectomy.For patients who underwent surgery for PUD,clinical course of marginal ulcers was more severe.

  16. Development of Mechanical Anchor for CFRP Tendons Using Integrated Sleeve

    DEFF Research Database (Denmark)

    Schmidt, Jacob Wittrup; Bennitz, Anders; Täljsten, Björn

    2010-01-01

    A durable and very efficient external strengthening system is achieved if steel tendons for post-tensioning applications can be replaced with CFRP (Carbon Fibre Reinforced Polymer) tendons and if reliable anchorage systems are developed,. This paper presents a newly developed and simple-to-use two......-piece wedge anchorage for CFRP tendons with an integrated sleeve and a differential angle between barrel and wedge sections. Three longitudinal slits are cut into the one-piece wedge, with one slit open and the other two stopping 1 mm from the inner wedge hole. The integrated sleeve holds the wedge's sections...... together during presetting and loading, resulting in a circumferential confined gripping of the CFRP tendon and optimized surface friction area. Therefore, the one-piece wedge differs from conventional wedge systems, where the wedges act separately with adjacent spaces, wedging the separate tendon sleeve...

  17. Laparoscopic gastric band removal complicated by splenosis.

    Science.gov (United States)

    Nicolas, Gregory; Schoucair, Ramy; Shimlati, Rasha; Rached, Linda; Khoury, George

    2016-08-01

    In any patient, the occurrence of postsplenectomy splenosis can complicate the planning of further surgeries. In our case, the gastric sleeve procedure was aborted, as it would have put the patient's life in danger. Therefore, only the gastric band was removed, eliminating future erosion.

  18. AN INVESTIGATION OF FASHION DESIGN AND PATTERN MAKING OF LADIES' JACKETS WITH DIFFERENT TYPES OF SLEEVES

    Directory of Open Access Journals (Sweden)

    Zlatina Kazlacheva

    2016-12-01

    Full Text Available The patterns of raglan, semi raglan, kimono, and dropped shoulder sleeves are made on one and the same constructional bases. In the constructional base the front and back in the underarm there are parts which have to be set to the both - the bodice and the sleeve. For the front and the back that is possible if the sleeve and a part of the bodice are separated by a design constructional seam. The type and design of the sleeve depends by the directions of the design constructional seam. If the seam joins the underarm and the neckline, or area around the neckline the type of sleeve is raglan. If the seam connects the underarm and the shoulder the type of sleeve is semi raglan. The type of the sleeve is kimono if the design constructional seam divides the bodice or the sleeve. In the dropped shoulder sleeve design constructional seam is located under the shoulder. The use of the main design principles, the possibilities for combinations between the four types of sleeves and the design with application of 3D elements are investigated. Raglan, semi raglan, kimono and dropped shoulder sleeves can be combined each other. In combined sleeves only one of seams which define the types of the sleeves is with decorative constructional function. The other ones have only decorative function. Design constructional seams which define the types of the sleeves can be used as contours of location or fixation of all types of 3D elements: pleats, goffers, flounces, tucks gathers, and draperies. The results of the investigation of application of the main design principles, combinations between different types of sleeves and possibility for the use of 3D elements facilitate the process of fashion design and pattern making and gives opportunity for variety of models.

  19. Fatigue Damage Mechanism of Oil Film Bearing Sleeve

    Institute of Scientific and Technical Information of China (English)

    HUANG Qing-xue; WANG Jian-mei; MA Li-feng; ZHAO Chun-jiang

    2007-01-01

    With the rapid development of the steel industry, to keep pace with the current trend of high speed, continuous, and large-scale production that focuses on automation and high levels of efficiency, many state-owned steel companies are being equipped with oil film bearings. Through long-term on-spot inspection and research on the fatigue failure of oil film bearing, three segments of annulated fatigue breakage were found axially along the inner surface of the bearing sleeve. In order to elucidate the reason for the three-segment annulated damage under rolling load, numerical boundary element method was adopted to analyze the contact behaviors between the sleeve and rollneck. Failure mechanism was discussed in detail, the distributions of contact stress were analyzed, and the service lives of the sleeve for different positions on the inner surface were quantitatively described, which provided an effective means to decrease wear and adhesive damage of the sleeve and to increase the load capacity of oil film bearing and its service life as well.

  20. Main steam inlet sleeves on steam turbines: External ultrasonic test and external sleeve replacement (closed HP-IP casing)

    Energy Technology Data Exchange (ETDEWEB)

    Lauro, M.; Arrighi, L.; Gaibazzi, I.

    1996-12-31

    ENEL has gained extensive experience on turbines with bell seals in relation to defect diagnosis and the conducting of on-site repairs on the main steam inlet sleeves. Several cases of cracking in the trepan radius area, and of retainer nut breakage, on this type of sleeve have caused very significant levels of turbine downtime that have demanded costly unscheduled work in order to open the HP-IP housing. These are related phenomena which were initially diagnosed by using temperature sensing at the IP turbine exhaust. As a consequence of the above, a technique was developed for detecting defects from outside the turbine by using non-destructive ultrasonic inspection (UT). A procedure for replacing the sleeves while the casing is closed was developed in conjunction with the manufacturer. The time required and the scope of operation are both of a limited nature. Initial trials were held with inspections carried out on an open turbine when there was a planned outage and then on a real case. Since completing these trials, periodic UT inspections have been made on (all) the sleeves and this check is being carried out on a continuing basis. Any changes in relevant indications are noted during these inspections, thereby allowing any replacement operation to be planned on site and at any time.

  1. Early outcome after emergency gastrectomy for complicated peptic ulcer disease.

    Science.gov (United States)

    Cheng, Mina; Li, W H; Cheung, M T

    2012-08-01

    OBJECTIVE. To analyse outcomes of patients who underwent emergency gastrectomy for complicated peptic ulcer disease. DESIGN. Prognostic study on a historical cohort. SETTING. A regional hospital in Hong Kong. PATIENTS. Patients who underwent emergency gastrectomy from 2000 to 2009 in our hospital. MAIN OUTCOME MEASURES. Primary outcome measures were in-hospital mortality and the predictors of such deaths. Secondary outcome measures were 7-day mortality, 30-day mortality, and morbidities. RESULTS. In all, 112 patients had emergency gastrectomies performed for complicated peptic ulcer disease during the study period. In-hospital mortality was 30%. In the univariate analysis, old age, duodenal ulcer, failed primary surgery, gastrojejunostomy anastomosis for reconstruction, hand-sewn technique for duodenal stump closure, use of a sump drain, low haemoglobin level, preoperative blood transfusion, prolonged prothrombin time, and high creatinine or bilirubin levels were associated with an increased risk of in-hospital mortality. In the multivariate analysis, failed primary surgery, old age, and high creatinine level turned out to be independent risk factors. CONCLUSIONS. Emergency gastrectomy should be considered seriously as the primary treatment option in appropriately selected elderly patients, instead of salvage procedures to repair a perforation or control bleeding by plication.

  2. Modification of early postoperative X-ray research after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Sapounov, S.

    1982-10-01

    A modification of the early postoperative X-ray research after gastrectomy is described. The application of gastrografin happens through a nasogastric tube. By changing the position of its tip during the screening control, and excellent and precise represention of the anastomotic region will be achieved. We present a research of 35 patients.

  3. DEVELOPMENT OF PERMANENT MECHANICAL REPAIR SLEEVE FOR PLASTIC PIPE

    Energy Technology Data Exchange (ETDEWEB)

    Hitesh Patadia

    2004-09-30

    The report presents a comprehensive summary of the project status related to the development of a permanent mechanical repair fitting intended to be installed on damaged PE mains under blowing gas conditions. Specifically, the product definition has been developed taking into account relevant codes and standards and industry input. A conceptual design for the mechanical repair sleeve has been developed which meets the product definition.

  4. Sleeve resection for delayed presentation of traumatic bronchial transection.

    LENUS (Irish Health Repository)

    Mohamed, H Y

    2010-02-01

    Tracheobronchial disruption is uncommon in blunt chest trauma. Many of these patients die before reaching the hospital. In the majority of survivors diagnosis is occasionally delayed resulting in complications like airway stenosis and lung collapse. Thus it is important to have radiological follow up after severe thoracic trauma. Sleeve resection can be an excellent option to conserve lung tissue in delayed presentation of bronchial transection.

  5. Systematic review of feasibility and safety of laparoscopic gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jiwen Jiang

    2012-01-01

    Objective: The purpose of the present study was to retrospectively and systematically evaluate the feasibility and safety of laparoscopic gastrectomy for gastric cancer.Methods: Research of prospective, randomized, controlled studies addressing laparoscopic gastrectomy versus open gastrectomy was screened through computer-based online system.Meta-analysis of acquired data was performed.The inverse variance method was used to test the significance of continuous data, while the Mantel-Haenszel method was used for dichotomous data.The chi-square test was used for evaluation of data heterogeneity.Homogenous data were calculated using the fixed effect model, and heterogeneous data were calculated using freedom model.Statistical data were expressed as 95% confidence interval (95% CI).Funnel plot was used for sensitivity analysis to show potential publication bias.Results: Five papers met the inclusion criteria, 164 cases underwent laparoscopic gastrectomy and 162 cases received open gastrectomy.Meta-analysis revealed that laparoscopic gastrectomy took longer operating time and removed fewer lymph nodes than open gastrectomy (both P < 0.01), but for early-stage gastric cancer, laparoscopic gastrectomy was superior to open gastrectomy in terms of blood loss and hospital stay (P < 0.01).But there were no significant differences in terms of time to resumption of oral intake, postoperative complications, postoperative morbidity rate, and tumor recurrence.Sensitive analysis demonstrated that publication bias existed in all indices to different extents with the exception of lymph node.Subgroup analysis showed that for D1 lymph node dissection, laparoscopic gastrectomy took significantly reduced blood loss than open gastrectomy.Conclusion: All these findings indicate that laparoscopic gastrectomy for early stage gastric cancer is feasible and safe.

  6. Elastic Knee Sleeves Limit Anterior Tibial Translation in Healthy Females

    Directory of Open Access Journals (Sweden)

    Robert Csapo, Simona Hosp, Ramona Folie, Robert Eberle, Michael Hasler, Werner Nachbauer

    2016-03-01

    Full Text Available Knee sleeves or braces represent auxiliary tools that have repeatedly been used by athletes, in an attempt to increase knee stability and, thus, reduce the risk of (recurrent ligamentous injuries. Since ACL injuries typically occur in situations involving either torsion or hyperextension of the knee, it has been speculated that braces might protect the ACL by countering excessive anterior translation of the tibia with respect to the femur (Beynnon et al., 1997. However, the preponderance of in vivo studies to test this hypothesis was performed in cohorts of patients suffering from existent ligamentous (Branch et al., 1988; Colville et al., 1986 or other knee injury (Beynnon et al., 1997; Fleming et al., 2000. This complicates the extrapolation of results to healthy subjects. Further, the braces used in these studies were mostly rigid constructs that consisted of either uni- or bilateral hinged bars (Rishiraj et al., 2009. Such braces might hinder performance (Veldhuizen et al., 1991 and would be rejected by the vast majority of healthy athletes. For these reasons, we would like to use this letter to the editor to report the results of our experiments investigating whether a relatively light elastic knee sleeve would limit the degree of anterior tibial translation in computerized arthrometry tests as performed in a sample of non-injured subjects. We recruited ten female college students (age: 23.4 ± 3.2 yrs, height: 1.68 ± 0.05 m, mass: 59.9 ± 5.5 kg who were free of acute or previous injury or any form of orthopaedic disease of the knee joints. The anterior displacement of the tibia was measured using the GNRB® computerized arthrometer (GeNouRob, Laval, France. With subjects lying in the supine position, the lower leg was firmly fixed with plastic caps mounted over the ankle joint and patella. An electrical pressure pad then exerted increasing pressure of up to 250 N on the calf, while a motion sensor, which was positioned on the ventral

  7. Mechanism Research on Melting Loss of Coppery Tuyere Small Sleeve in Blast Furnace

    Science.gov (United States)

    Chai, Yi-Fan; Zhang, Jian-Liang; Ning, Xiao-Jun; Wei, Guang-Yun; Chen, Yu-Ting

    2016-01-01

    The tuyere small sleeve in blast furnace works under poor conditions. The abnormal damage of it will severely affect the performance of the blast furnace, thus it should be replaced during the damping down period. So it is of great significance that we study and reduce the burnout of tuyere small sleeve. Melting loss is one case of its burnout. This paper studied the reasons of tuyere small sleeve's melting loss, through computational simulation and microscopic analysis of the melting section. The research shows that the temperature of coppery tuyere small sleeve is well distributed when there is no limescale in the lumen, and the temperature increases with the thickness of limescale. In addition, the interruption of circulating water does great harm to the tuyere small sleeve. The melting loss of tuyere small sleeve is caused by iron-slag erosion, with the occurrence of the melt metallurgical bonding and diffusion metallurgical combination.

  8. Totally Laparoscopic Gastrectomy for Gastric Cancer Associated with Recklinghausen's Disease

    Directory of Open Access Journals (Sweden)

    Yoshihisa Sakaguchi

    2010-01-01

    Full Text Available This paper documents the first case of gastric cancer associated with Recklinghausen's disease, which was successfully treated by a totally laparoscopic operation. A 67-year-old woman with Recklinghausen's disease was referred to this department to undergo surgical treatment for early gastric cancer. The physical examination showed multiple cutaneous neurofibromas throughout the body surface, which made an upper abdominal incision impossible. Laparoscopic surgery requiring only small incisions was well indicated, and a totally laparoscopic distal gastrectomy with lymph node dissection was performed. Billroth I reconstruction was done intra-abdominally using a delta-shaped anastomosis. The patient followed a satisfactory postoperative course with no complications. Since the totally laparoscopic gastrectomy has many advantages over open surgery, it should therefore be preferentially used as a less invasive treatment in the field of gastric cancer.

  9. A Multifactorial Analysis of Reconstruction Methods Applied After Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Oktay Büyükaşık

    2010-12-01

    Full Text Available Aim: The aim of this study was to evaluate the reconstruction methods applied after total gastrectomy in terms of postoperative symptomology and nutrition. Methods: This retrospective study was conducted on 31 patients who underwent total gastrectomy due to gastric cancer in 2. Clinic of General Surgery, SSK Ankara Training Hospital. 6 different reconstruction methods were used and analyzed in terms of age, sex and postoperative complications. One from esophagus and two biopsy specimens from jejunum were taken through upper gastrointestinal endoscopy from all cases, and late period morphological and microbiological changes were examined. Postoperative weight change, dumping symptoms, reflux esophagitis, solid/liquid dysphagia, early satiety, postprandial pain, diarrhea and anorexia were assessed. Results: Of 31 patients,18 were males and 13 females; the youngest one was 33 years old, while the oldest- 69 years old. It was found that reconstruction without pouch was performed in 22 cases and with pouch in 9 cases. Early satiety, postprandial pain, dumping symptoms, diarrhea and anemia were found most commonly in cases with reconstruction without pouch. The rate of bacterial colonization of the jejunal mucosa was identical in both groups. Reflux esophagitis was most commonly seen in omega esophagojejunostomy (EJ, while the least-in Roux-en-Y, Tooley and Tanner 19 EJ. Conclusion: Reconstruction with pouch performed after total gastrectomy is still a preferable method. (The Medical Bulletin of Haseki 2010; 48:126-31

  10. Investigation of Causes of Scrap Occurrence in Thread Cutting on Steel Sleeves for Motorcar Industry

    Directory of Open Access Journals (Sweden)

    Marušić, V.

    2007-01-01

    Full Text Available This paper studies causes of scrap occurrence, wear and breakage of cutters during thread cutting of steel sleeves poured in Al die castings of motor car engine components. It was concluded that the reason for occurrence of problems with thread cutting of sleeves most probably should be attributed to the fact whether hardness value reaches 200 HB or over 250 HB. The most probable reason for over wear and consequently to breakage of cutters and scrap occurrence, although castings display top quality, lies in the fact that the internal diameter of sleeves frequently falls down under minimally allowed tolerances for threaded sleeves.

  11. The effects of stochastic resonance electrical stimulation and neoprene sleeve on knee proprioception

    Directory of Open Access Journals (Sweden)

    Olcott Chris W

    2009-02-01

    Full Text Available Abstract Background A variety of knee injuries and pathologies may cause a deficit in knee proprioception which may increase the risk of reinjury or the progression of disease. Stochastic resonance stimulation is a new therapy which has potential benefits for improving proprioceptive function. The objective of this study was to determine if stochastic resonance (SR stimulation applied with a neoprene sleeve could improve knee proprioception relative to a no-stimulation/no-sleeve condition (control or a sleeve alone condition in the normal, healthy knee. We hypothesized that SR stimulation when applied with a sleeve would enhance proprioception relative to the control and sleeve alone conditions. Methods Using a cross-over within subject design, twenty-four healthy subjects were tested under four combinations of conditions: electrical stimulation/sleeve, no stimulation/sleeve, no stimulation/no sleeve, and stimulation/no sleeve. Joint position sense (proprioception was measured as the absolute mean difference between a target knee joint angle and the knee angle reproduced by the subject. Testing was conducted during both partial-weight bearing (PWB and non-weight bearing (NWB tasks. Differences in joint position sense between the conditions were evaluated by repeated-measures analysis of variance testing. Results Joint position sense error during the stimulation/sleeve condition (2.48° ± 1.32° was found to be more accurate (P Conclusion These results suggest that SR electrical stimulation when combined with a neoprene sleeve is an effective modality for enhancement of joint proprioception in the PWB knee. We believe these results suggest the need for further study of the potential of SR stimulation to correct proprioceptive deficits in a clinical population with knee injury/pathology or in subjects at risk of injury because of a proprioceptive deficit.

  12. Prophylactic Laparoscopic Total Gastrectomy with Jejunal Pouch Reconstruction in Patients Carrying a CDH1 Germline Mutation

    NARCIS (Netherlands)

    Haverkamp, L.; Sluis, P.C. van der; Ausems, M.G.; Horst, S. van der; Siersema, P.D.; Ruurda, J.P.; Offerhaus, G.J.; Hillegersberg, R. van

    2015-01-01

    BACKGROUND: For patients with an identified germline E-cadherin-1 (CDH1) mutation, prophylactic gastrectomy is the treatment of choice to eliminate the high risk of developing diffuse gastric cancer. Laparoscopic total gastrectomy with jejunal pouch reconstruction is a novel approach that may be esp

  13. Nylon Sleeve for Cavity Amplifier Holds Tuning Despite Heat

    Science.gov (United States)

    Derr, Lloyd

    1964-01-01

    The problem: Detuning of cavity amplifiers with change in temperature. This results in deterioration of the performance of the amplifier at its design frequency. In cavity amplifiers and filters it is desirable that constant performance be maintained regardless of thermal changes. These changes often cause an "off resonance shift" in a cavity filter and a deterioration of performance in a cavity amplifier. The solution: Mount the tuning probe in a nylon sleeve. Thermal expansion and contraction of the nylon nullifies unwanted capacitive and inductive changes in the resonant elements.

  14. Robotic versus open gastrectomy for gastric cancer: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Guixiang Liao

    Full Text Available AIM: To evaluate the safety and efficacy of robotic gastrectomy versus open gastrectomy for gastric cancer. METHODS: A comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Knowledge was performed. Systematic review was carried out to identify studies comparing robotic gastrectomy and open gastrectomy in gastric cancer. Intraoperative and postoperative outcomes were also analyzed to evaluate the safety and efficacy of the surgery. A fixed effects model or a random effects model was utilized according to the heterogeneity. RESULTS: Four studies involving 5780 patients with 520 (9.00% cases of robotic gastrectomy and 5260 (91.00% cases of open gastrectomy were included in this meta-analysis. Compared to open gastrectomy, robotic gastrectomy has a significantly longer operation time (weighted mean differences (WMD =92.37, 95% confidence interval (CI: 55.63 to 129.12, P<0.00001, lower blood loss (WMD: -126.08, 95% CI: -189.02 to -63.13, P<0.0001, and shorter hospital stay (WMD = -2.87; 95% CI: -4.17 to -1.56; P<0.0001. No statistical difference was noted based on the rate of overall postoperative complication, wound infection, bleeding, number of harvested lymph nodes, anastomotic leakage and postoperative mortality rate. CONCLUSIONS: The results of this meta-analysis suggest that robotic gastrectomy is a better alternative technique to open gastrectomy for gastric cancer. However, more prospective, well-designed, multicenter, randomized controlled trials are necessary to further evaluate the safety and efficacy as well as the long-term outcome.

  15. Failure analysis of rutile sleeves in MC3080 lightning arrestor connectors.

    Energy Technology Data Exchange (ETDEWEB)

    Kilgo, Alice C.; Monroe, Saundra L.; Watson, Chad Samuel; Ernest, Terry L.

    2006-02-01

    The purpose of this SAND Report is to document efforts in the extraction and failure analyses of sleeve-style Lightning Arrestor Connectors (LACs). Several MC3080 and MC3079 LACs were recovered from the field and tested as part of the Enhanced Surveillance Campaign. A portion of these LACs failed retesting. Terry Ernest (01733), the LAC Component Engineer, provided eleven MC3080 LACs for evaluation where four of the LACs failed IR/DCW and one failed FRB requirements. The extraction of rutile sleeves from failed LACs was required to determine the source of failure. Rutile sleeves associated with connector function failures were examined for cracks, debris as well as any other anomalies which could have caused the LAC to not function properly. Sleeves that failed FRB or that experienced high FRB exhibited high symmetry, smooth surface, long-flow amicon, and slightly over-sized inside diameter. LACs that failed DCW or IR requirements had rutile sleeves that exhibited breakdown tracks.

  16. Control study of arterial interventional chemotherapy before radical gastrectomy for gastric cancer and simple radical gastrectomy for gastric cancer in treatment of advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Bin Liu

    2016-01-01

    Objective: To analyze the differences in effect of arterial interventional chemotherapy before radical gastrectomy for gastric cancer and simple radical gastrectomy for gastric cancer in treatment of advanced gastric cancer.Methods:A total of 86 cases of patients with advanced gastric cancer treated in our hospital were selected as research subjects and randomly divided into two groups, observation group received arterial interventional chemotherapy combined with radical gastrectomy for gastric cancer, control group received simple radical gastrectomy for gastric cancer, and then differences in prognosis-associated factors, MMP and Leptin contents as well as tumor marker and telomerase activity levels of two groups were compared.Results:Serum HER-2/neu ECD level of observation group was lower than that of control group, and serum DKK-1, TS and TP levels were higher than those of control group; at each point in time after treatment, serum CA72-4 and CA50 contents of observation group were lower than those of control group; intraoperative MMP-2, MMP-7, MMP-9 and Leptin levels in gastric cancer tissue of observation group were lower than those of control group; telomerase activity value in gastric cancer tissue of observation group after treatment was lower than that of control group, and both PGⅠ positive expression rate and PGⅠ/ PGⅡ ratio were higher than those of control group.Conclusion: Arterial interventional chemotherapy before radical gastrectomy for gastric cancer can lower tumor malignancy, promote the curative effect of radical gastrectomy for gastric cancer and improve long-term prognosis.

  17. Laparoscopic Gastric Sleeve and Micronutrients Supplementation: Our Experience

    Directory of Open Access Journals (Sweden)

    D. Capoccia

    2012-01-01

    Full Text Available Background. Laparoscopic gastric sleeve (LGS has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LGS attenuates micronutrients deficiencies and associated complications that were typically observed following malabsorptive procedures. The aim of this study was to assess some micronutrients and mineral deficiencies in patients undergoing LGS. Methods. In the period between July 2008 and April 2010, 138 obese patients (110 females and 28 males with mean BMI 44.4 kg/m2 ± 6.5, mean age 43.9±10.9 years were enrolled and underwent LGS. Patients were followed up with routine laboratory tests and anthropometric measurements and assessed for nutritional status, as regards vitamin B12, folic acid, iron, hemoglobin, calcium, and vitamin D, every three months throughout 12 months. Results. 12 months after sleeve, patients did not show iron deficiency and/or anemia; plasma calcium levels were in the normal range without supplementation from the sixth month after the operation. Vitamin B12 and folic acid were adequately supplemented for all the follow-up period. Vitamin D was in suboptimal levels, despite daily multivitamin supplementation. Conclusion. In this study, we showed that LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrients deficiencies and greater weight loss does not require higher dosage of multivitamins.

  18. Clinicopathological characteristics and prognosis of early gastric cancer after gastrectomy

    Institute of Scientific and Technical Information of China (English)

    WANG Yong-xiang; SHAO Qin-shu; YANG Qiong; WANG Yuan-yu; YANG Jin; ZHAO Zhong-kuo; XU Ji; YE Zai-yuan

    2012-01-01

    Background Assessment of lymph node metastasis (LNM) is important in early gastric cancer (EGC) and affects treatment decisions.However,the relationship between clinicopathological characteristics and LNM in EGC remains unclear.This study therefore explored favorable predictors of LNM in EGC.Methods A total of 716 specimens from gastric cancer patients who underwent curative gastrectomy between 1996 and 2003 at Zhejiang Provincial People's Hospital were reviewed.Forty-five cases were EGC,and clinicopathological characteristics such as gender,age,tumor size,location,gross type,differentiation,invasion depth,and vessel involvement were assessed to identify predictive factors for LNM and survival time.Results The overall cumulative 5-year survival rate of EGC patients was 88.92%.Among these,22.4% developed LNM,which was associated with a poor 5-year survival rate of only 72.7%.Patients with tumors larger than 2 cm in diameters,with depth of tumor invasion to the submucosa,and with positive lymphatic or nerve involvement were also inclined to have poorer survival performances.EGC limited to the mucosa but poorly differentiated also had a high risk for LNM.Multivariate analysis identified lymphatic invasion and tumor size as independent prognosis factors related to survival in EGC patients.Conclusions Careful planning is required in EGC patients at high risk of lymph node metastases.Endoscopic mucosal resection or endoscopic submucosal dissection and laparoscopic partial gastrectomy should be cautiously used in EGC,and curative gastrectomy including lymphatic dissection and postoperative adjuvant therapy might be considered to improve the prognosis.

  19. Fratura na patela em crianças (fraturas do tipo "sleeve" Patellar fractures in children (sleeve-type fractures

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    Pedro José Labronici

    2005-01-01

    Full Text Available Os autores descrevem um caso raro de fratura de patela num paciente de 11 anos de idade onde o diagnóstico inicial não foi realizado. O diagnóstico "sleeve fracture" ou fratura por desluvamento foi revisado quanto a diversos aspectos como o diagnóstico clínico, o auxílio por meio de imagem e o tratamento mais adequado. Concluíram que, embora rara, a fratura deve ser lembrada e que o tratamento mais adequado é o cirúrgico.The authors describe a rare case of patellar fracture in an 11 year-old patient in whom an early diagnosis was not provided. The sleeve fracture - or ungloving fracture - diagnosis was reviewed for various aspects such as clinical diagnosis, imaging tests aid and most suitable treatment. They concluded that, although rare, this kind of fracture should always be remembered, and that the most suitable treatment is surgery.

  20. EFFECTS OF ENTERAL AND PARENTERAL NUTRITION ON GASTROENTERIC HORMONES AND GASTRIC MOTILITY AFTER SUBTOTAL GASTRECTOMY

    Institute of Scientific and Technical Information of China (English)

    Wei-ming Kang; Jian-chun Yu; Qun Zhang; Mei-yun Ke; Jia-ming Qian

    2008-01-01

    Objective To investigate the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motilityand gastroenteric hormones after subtotal gastrectomy.Methods Forty-one patients underwent gastrectomy were randomly divided into EN group ( n = 20) and PN group (n =21 ). From the fast postoperative day to the seventh day, patients received either EN (EN group) or PN (Pnplasma motilin (MTL), and plasma cholecystokinin (CCK) were measured on preoperative day, the fast and seventh postoperative day. Electrogastrography (EGG) was measured on preoperative day and the seventh postoperative day.Results Compared with preoperation, blood GAS, MTL, and CCK levels of 41 patients decreased significantlyon the first day after subtotal gastrectomy (P<0. 001), but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained ( P <0. 001 ). On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group ( P < 0.05 ).There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper-atively.Conclusions The levels of gastroenteritic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.

  1. Is prophylactic placement of drains necessary after subtotal gastrectomy?

    Institute of Scientific and Technical Information of China (English)

    Manoj Kumar; Seung Bong Yang; Vijay Kumar Jaiswal; Jay N Shah; Manish Shreshtha; Rajesh Gongal

    2007-01-01

    AIM: To determine the evidence-based values of prophylactic drainage in gastric cancer surgery.METHODS: One hundred and eight patients, who underwent subtotal gastrectomy with D1 or D2 lymph node dissection for gastric cancer between January 2001 and December 2005, were divided into drain group or no-drain group. Surgical outcome and post-operative complications within four weeks were compared between the two groups.RESULTS: No significant differences were observed between the drain group and no-drain group in terms of operating time (171±42 min vs 156±39 min), number of post-operative days until passage of flatus (3.7±0.5d vs 3.5±1.0 d), number of post-operative days until initiation of soft diet (4.9±0.7 d vs 4.8±0.8 d), length of post-operative hospital stay (9.3±2.2 d vs 8.4±2.4 d), mortality rate (5.4% vs 3.8%), and overall postoperative complication rate (21.4% vs19.2%).CONCLUSION: Prophylactic drainage placement is not necessary after subtotal gastrectomy for gastric cancer since it does not offer additional benefits for the patients.

  2. Increased output of blown film extrusion lines by using a cooling sleeve

    Science.gov (United States)

    Hopmann, Christian; Windeck, Christian; Hennigs, Marco

    2014-05-01

    Production efficiency is one of the most important demands in blown film production. In many cases, the cooling power is the limiting factor for an increased output. A possible solution for a better cooling is the use of a cooling sleeve right after the outlet of the die in addition to the conventional air rings and internal bubble cooling (IBC). At the Institute of Plastics Processing (IKV), first tests were conducted to investigate the advantages of the use of a cooling sleeve. Therefore, the influence of several geometries of the cooling sleeve surface and different cooling sleeve temperatures on the process stability and the mechanical and optical film properties is investigated. The cooling sleeve surfaces differ in the tapping between inlet and outlet diameter from 0 % (cylindric) to 10 % (conical). The tests show that a high amount of tapping as well as too high resp. low cooling sleeve temperatures cause process instabilities and an uneven thickness profile of the film. While the mechanical film properties (E-modulus, elongation at break, tensile strength) of the films produced by the use of a cooling sleeve (cs-films) do not significantly differ from the values of the reference films, the haze of the cs-films was higher and therefore worse. A measurement of the bubble temperatures above the air ring shows that the use of a cooling sleeve can significant lower the bubble temperature at this point. Because of this and because of the results of the mechanical tests, the principle of a contact cooling is generally applicable. Further research and development on the geometry of the cooling sleeve surface has to be done to improve the process stability and the haze for a possible industrial application.

  3. Immediate effects of an elastic knee sleeve on frontal plane gait biomechanics in knee osteoarthritis.

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    Raphael Schween

    Full Text Available Osteoarthritis of the knee affects millions of people. Elastic knee sleeves aim at relieving symptoms. While symptomatic improvements have been demonstrated as a consequence of elastic knee sleeves, evidence for biomechanical alterations only exists for the sagittal plane. We therefore asked what effect an elastic knee sleeve would have on frontal plane gait biomechanics.18 subjects (8 women, 10 men with osteoarthritis of the medial tibiofemoral joint walked over ground with and without an elastic knee sleeve. Kinematics and forces were recorded and joint moments were calculated using an inverse dynamics approach. Conditions with sleeve and without sleeve were compared with paired t-Tests.With the sleeve, knee adduction angle at ground contact was reduced by 1.9 ± 2.1° (P = 0.006. Peak knee adduction was reduced by 1.5 ± 1.6° (P = 0.004. The first peak knee adduction moment and positive knee adduction impulse were decreased by 10.1% (0.74 ± 0.9 Nm • kg-1; P = 0.002 and 12.9% (0.28 ± 0.3 Nm • s • kg-1; P < 0.004, respectively.Our study provides evidence that wearing an elastic knee sleeve during walking can reduce knee adduction angles, moments and impulse in subjects with knee osteoarthritis. As a higher knee adduction moment has previously been identified as a risk factor for disease progression in patients with medial knee osteoarthritis, we speculate that wearing a knee sleeve may be beneficial for this specific subgroup.

  4. Validation of sleeve of straight union type B for leaks

    Energy Technology Data Exchange (ETDEWEB)

    Teutonico, Mauricio; Fazzini, Pablo [Gie S.A., Buenos Aires (Argentina)

    2009-07-01

    Analytic study and experimental validation of type B sleeve with overlapping, were done in order to determine whether they are suitable for used as permanent leaks repair in hydrocarbons transport lines. All relevant background of this type of repair was analyzed, following the guidelines defined by applicable regulations (ASME B31.8 and ASME B31.4) and modeled by finite elements methods. Solicitations under internal pressure of each one of the reinforcement parts were analyzed. All solicitations involved in welded unions were studied, so as the reinforcement effectiveness when it is filled with internal gap filler. Experimental tests were developed, consisted on the reinforcement installation upon damaged pipes and the following hydrostatic test. These tests were assisted by a digitalized measurement, to determine the solicitations at different parts of the reinforcement; strain gauges were used for this task. (author)

  5. [Pre and postoperative adherence to Mediterranean-like diet and its effect on weight loss and cardiovascular risk factors after sleeve gastrectomy].

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Boix, Evangelina; Bozhychko, Maryana; Miren Del Campo, Jone; Martínez, Rosana; Bonete, José María; Calpena, Rafael

    2014-10-01

    Introducción: El cumplimiento de la dieta mediterránea es cada vez menor, incluso en países mediterráneos, a pesar de estar considerada como un ejemplo de dieta saludable. Objetivos: El objetivo principal de este trabajo fue evaluar la adherencia a la dieta mediterránea en pacientes obesos mórbidos antes y después de ser sometidos a una gastrectomía vertical como técnica bariátrica. Así mismo, se analizó también la influencia de la adherencia sobre la pérdida de peso conseguida y sobre la evolución de los factores de riesgo cardiovasculares. Material y métodos: Se realizó un estudio observacional prospectivo de todos los pacientes sometidos a una gastrectomía vertical entre octubre de 2010 y mayo de 2012. Los pacientes rellenaron un test KIDMED (evalúa la adherencia a la dieta mediterránea) antes de la operación y 1 año después de la misma. Resultados: Se incluyeron un total de 50 pacientes en el estudio. Antes de la operación, el 30% de los pacientes estudiados presentaban una baja adherencia a la dieta mediterránea, el 64% una adherencia moderada y sólo un 6% una buena adherencia. Al año de la intervención, sólo un 2% de los casos presentaban una baja adherencia, un 58% una adherencia moderada y un 40% una buena adherencia a la dieta mediterránea (p=0,02). Se estableció una correlación inversa entre el aumento de puntuación del test KIDMED (indicador de mayor adherencia a la dieta mediterránea) y la pérdida de peso (Spearman -0,357; p=0,008), el descenso en los valores de colesterol total (Spearman -0,442; p=0,003) y de LDL-colesterol (Spearman -0,464; p=0,002). Además, se observó una correlación directa entre el aumento de puntuación del test KIDMED y el incremento en los niveles de HDL-colesterol (Spearman 0,562; p=0,001). Conclusiones: Después de la operación, los pacientes cumplen mejor los patrones de dieta mediterránea. Aquellos pacientes con mejor adherencia a la misma, consiguieron una mayor pérdida de peso y una mejoría significativa del perfil lipídico.

  6. Risk of Dumping Syndrome after Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Early Results of a Multicentre Prospective Study.

    Science.gov (United States)

    Ramadan, M; Loureiro, M; Laughlan, K; Caiazzo, R; Iannelli, A; Brunaud, L; Czernichow, S; Nedelcu, M; Nocca, D

    2016-01-01

    Background. Bariatric surgery is an important field of surgery. An important complication of bariatric surgery is dumping syndrome (DS). Aims. To evaluate the incidence of DS in patients undergoing bariatric surgery. Methods. 541 patients included from 5 nutrition and bariatric centers in France underwent either LSG or LRYGB. They were evaluated at 1 month (M1) and 6 months (M6) postoperatively by an interview and completion of a dumping syndrome questionnaire. Results. 268 patients underwent LSG (Group A) and 273 underwent LRYGB. From the LRYGB patients 229 had mechanical gastrojejunoanal anastomosis with 30 mm linear stapler (Group B) and 44 had manual (hand sewn) 15 mm gastrojejunal anastomosis (Group C). Overall incidence of DS was 8.5% at M1 and M6. In LSG group (Group A), only 4 patients (1.49%) reported episodes of DS at M1 and 3 (1.12%) at M6. In Group B, 41 patients (17.90%) reported episodes of DS at M1 and 43 (18.78%) at M6. Group C experienced one case (2.27%) of DS at M1 and none (0%) at M6. Conclusions. Patients undergoing LRYGB, especially with larger gastrojejunal anastomosis, are more prone to developing DS following surgery than patients undergoing LSG or LRYGB with calibrated manual anastomosis.

  7. Multimodal analgesia with pregabalin and dexmedetomidine in morbidly obese patients undergoing laparoscopic sleeve gastrectomy: A prospective randomized double blind placebo controlled study

    Directory of Open Access Journals (Sweden)

    Atef Kamel Salama

    2016-07-01

    Conclusions: The combination of preoperative oral pregabalin and intraoperative dexmedetomidine infusion decreased intraoperative fentanyl use and ensured postoperative better pain control and less postoperative opioid consumption.

  8. Risk of Dumping Syndrome after Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Early Results of a Multicentre Prospective Study

    Science.gov (United States)

    Laughlan, K.; Caiazzo, R.; Brunaud, L.; Czernichow, S.; Nocca, D.

    2016-01-01

    Background. Bariatric surgery is an important field of surgery. An important complication of bariatric surgery is dumping syndrome (DS). Aims. To evaluate the incidence of DS in patients undergoing bariatric surgery. Methods. 541 patients included from 5 nutrition and bariatric centers in France underwent either LSG or LRYGB. They were evaluated at 1 month (M1) and 6 months (M6) postoperatively by an interview and completion of a dumping syndrome questionnaire. Results. 268 patients underwent LSG (Group A) and 273 underwent LRYGB. From the LRYGB patients 229 had mechanical gastrojejunoanal anastomosis with 30 mm linear stapler (Group B) and 44 had manual (hand sewn) 15 mm gastrojejunal anastomosis (Group C). Overall incidence of DS was 8.5% at M1 and M6. In LSG group (Group A), only 4 patients (1.49%) reported episodes of DS at M1 and 3 (1.12%) at M6. In Group B, 41 patients (17.90%) reported episodes of DS at M1 and 43 (18.78%) at M6. Group C experienced one case (2.27%) of DS at M1 and none (0%) at M6. Conclusions. Patients undergoing LRYGB, especially with larger gastrojejunal anastomosis, are more prone to developing DS following surgery than patients undergoing LSG or LRYGB with calibrated manual anastomosis. PMID:27242898

  9. Combined liver transplantation and sleeve gastrectomy for end-stage liver disease in a bariatric patient: First European case-report

    Directory of Open Access Journals (Sweden)

    Laura Tariciotti, PhD MD

    2016-01-01

    Conclusion: Despite the ideal approach to the management of the obese LT patients remains unknown, we strongly support the combined procedure during LT in selected patients, offering advantages in terms of allograft and patient survival, maintenance of weigh loss that will ultimately reduce obese related co-morbidities.

  10. Assessment of Surgical Complications in Morbid Obese Patients, The Candidates for 2 Methods of Laparoscopic Bariatric Surgery (Laparoscopic Gastric Bypass, Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Pazouki

    2015-11-01

    Full Text Available Background In 2005, obesity rate was declared 396 million worldwide, which has been doubled in the last 20 years (compared with 1985. Obesity has a strong correlation with a pool of comorbidities and consequences. Although many modules, including behavioural approach and medications have presented particular short-term unreliable methods to reduce and control the body weight in morbid obesity, only 5 - 10% of weight loss was achieved, which is usually regained overtime, compared with 50 - 75% success rate in bariatric surgery. Objectives This retrospective study tried to monitor weight loss after LRYGB and LSG in morbid obese patients referred to a known center in Tehran through a one-year follow up. Materials and Methods Participants were selected regarding the U.S. National Institute of Health (NIH guidelines, which indicates BMI > 40 kg/m2 alone, or BMI > 35 kg/m2 in addition to comorbidities and failure of non-surgical attempts to control their weight. They were visited at points of one, three, six, and 12 months postoperatively to collect information about weight loss, BMI, and complications in addition to percent excess weight loss (EWL%. The percentage of failure was computed to the proportion of patients who had EWL% < 25 to the total number of operated patients in a year. Results Significant decrease in BMI and weight were achieved in all postoperative visits (for all of them, P value < 0.0001, while no significant difference was found in which the parameters between two studied procedures were in this regard. Conclusions To sum up, LRYGB and LSG deserve an overall preference not only in current study, but also in the majority of performances up to now. Nevertheless it is urgent the relevant studies to confirm the preference or improve this kind of bariatric surgery in order to diminish complications as far as possible.

  11. Post-gastrectomy acute pancreatitis in a patient with gastric carcinoma and pancreas divisum

    Institute of Scientific and Technical Information of China (English)

    I-Ming Kuo; Frank Wang; Keng-Hao Liu; Yi-Yin Jan

    2009-01-01

    Gastrectomy is commonly performed for both benign and malignant lesions. Although the incidence of post-gastrectomy acute pancreatitis (PGAP) is low compared to other well-recognized post-operative complications, it has been reported to be associated with a high mortality rate. In this article, we describe a 70-year-old man with asymptomatic pancreatic divisum who underwent palliative subtotal gastrectomy for an advanced gastric cancer with liver metastasis. His postoperative course was complicated by acute pancreatitis and intra-abdominal sepsis. The patient eventually succumbed to multiple organ failure despite surgical debridement and drainage, together with aggressive antibiotic therapy and nutritional support. For patients with pancreas divisum or dominant duct of Santorini who fail to follow the normal post-operative course after gastrectomy, clinicians should be alert to the possibility of PGAP as one of the potential diagnoses. Early detection and aggressive treatment of PGAP might improve the prognosis.

  12. Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

    OpenAIRE

    Portanova Michel

    2010-01-01

    Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent to...

  13. Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients

    Institute of Scientific and Technical Information of China (English)

    Dong Yi Kim; Jae Kyoon Joo; Seong Yeob Ryu; Young Jin Kim; Shin Kon Kim; Yong Yeon Jung

    2003-01-01

    We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.

  14. Segmental gastrectomy with radical lymph node dissection for early gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Takeru; Matsuda; Kunihiko; Kaneda; Manabu; Takamatsu; Keishi; Aishin; Masahide; Awazu; Akiko; Okamoto; Katsunori; Kawaguchi

    2010-01-01

    AIM: To describe a new surgical technique and evaluate the early results of segmental gastrectomy (SG) with modified D2 lymph node (LN) dissection for early gastric cancer (EGC). METHODS: Fourteen patients with EGC underwent SG with modified D2 dissection from 2006 to 2008. Their operative results and postoperative courses were compared with those of 17 patients who had distal gastrectomy (DG) for EGC during the same period. RESULTS: Operating time, blood loss, and hospital stay were similar between the 2 g...

  15. Simulation on Mechanical Behaviors of Oil-film Bearing Sleeve by Elastic Interference Fit

    Institute of Scientific and Technical Information of China (English)

    HUANG Qingxue; WANG Jianmei; ZHAO Chunjiang; MA Lifeng

    2006-01-01

    Oil film bearing, which works on thin film between sleeve and bush, is widely used in steel industry due to the characteristics of high efficiency and low noise, etc. The backup roll of 1 580PC hot strip mill invested by some steel corporation has been equipped with such bearing. During the process of setup&disassembly and usage period, the sleeve has been dramatically damaged, which results in production accidents and decreases its service life, thus heavily influencing steel production. Aimed at such puzzles, under specific loadcase, mechanical properties of bearing sleeve, as well as estimation of contact status and adhesive force of sleeve by interference fit, are quantitatively simulated by finite element method, which establishes an mechanical foundation for improving the load capacity of bearing and decreasing its wear and adhesion damages. Finally, some measures and conclusions are drawn.

  16. Ataxic gait following total gastrectomy for gastric cancer

    Science.gov (United States)

    Hwang, Chang Ho; Park, Dong Jin; Kim, Gyu Yeol

    2016-01-01

    A 58-year-old woman, who had undergone total gastrectomy for early gastric cancer 9 years previously, visited the outpatient clinic complaining of progressive difficulty in walking for 15 d. Laboratory examinations showed macrocytic anemia and a decreased serum vitamin B12 concentration and increased serum concentrations of folate, vitamin E and copper. Magnetic resonance imaging showed multifocal high signal intensities along the posterior column of the cervical and thoracic spinal cord. Treatment consisted of intramuscular injections of vitamin B12 for 7 d, which increased her serum level of vitamin B12 to normal. This was followed by weekly intramuscular injections of vitamin B12 for another 2 wk and oral administration of vitamin B12 three times per day. After comprehensive rehabilitation for 4 wk, she showed sufficient improvements in strength and ataxic gait, enabling her to return to her normal daily activities. PMID:27729749

  17. [Wernicke encephalopathy after subtotal gastrectomy for morbid obesity].

    Science.gov (United States)

    Gabaudan, C; La-Folie, T; Sagui, E; Soulier, B; Dion, A-M; Richez, P; Brosset, C

    2008-05-01

    Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.

  18. Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy

    Directory of Open Access Journals (Sweden)

    Yano Seiji

    2011-05-01

    Full Text Available Abstract Here we report the method of anastomosis based on double stapling technique (hereinafter, DST using a trans-oral anvil delivery system (EEATM OrVilTM for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection. As a basic technique, laparoscopic total gastrectomy employed Roux-en-Y reconstruction, laparoscopic proximal gastrectomy employed double tract reconstruction, and end-to-side anastomosis was used for the cut-off stump of the esophagus and lifted jejunum. We used EEATM OrVilTM as a device that permitted mechanical purse-string suture similarly to conventional EEA, and endo-Surgitie. After the gastric lymph node dissection, the esophagus was cut off using an automated stapler. EEATM OrVilTM was orally and slowly inserted from the valve tip, and a small hole was created at the tip of the obliquely cut-off stump with scissors to let the valve tip pass through. Yarn was cut to disconnect the anvil from a tube and the anvil head was retained in the esophagus. The end-Surgitie was inserted at the right subcostal margin, and after the looped-shaped thread was wrapped around the esophageal stump opening, assisting Maryland forceps inserted at the left subcostal and left abdomen were used to grasp the left and right esophageal stump. The surgeon inserted anvil grasping forceps into the right abdomen, and after grasping the esophagus with the forceps, tightened the end Surgitie, thereby completing the purse-string suture on the esophageal stump. The main unit of the automated stapler was inserted from the cut-off stump of the lifted jejunum, and a trocar was made to pass through. To prevent dropout of the small intestines from the automated stapler, the automated stapler and the lifted jejunum were fastened with silk thread, the abdomen was again inflated, and the lifted jejunum was led into the abdominal cavity. When it was confirmed that the automated stapler and center rod

  19. Modeling and testing of a knitted-sleeve fluidic artificial muscle

    Science.gov (United States)

    Ball, Erick J.; Meller, Michael A.; Chipka, Jordan B.; Garcia, Ephrahim

    2016-11-01

    The knitted-sleeve fluidic muscle is similar in design to a traditional McKibben muscle, with a separate bladder and sleeve. However, in place of a braided sleeve, it uses a tubular-knit sleeve made from a thin strand of flexible but inextensible yarn. When the bladder is pressurized, the sleeve expands by letting the loops of fiber slide past each other, changing the dimensions of the rectangular cells in the stitch pattern. Ideally, the internal volume of the sleeve would reach a maximum when its length has contracted by 2/3 from its maximum length, and although this is not reachable in practice, preliminary tests show that free contraction greater than 50% is achievable. The motion relies on using a fiber with a low coefficient of friction in order to reduce hysteresis to an acceptable level. In addition to increased stroke length, potential advantages of this technique include slower force drop-off during the stroke, more useable energy in certain applications, and greater similarity to the force-length relationship of skeletal muscle. Its main limitation is its potentially greater effect from friction compared to other fluidic muscle designs.

  20. Morbidity and mortality after neoadjuvant therapy and sleeve lobectomyin N2-disease

    Institute of Scientific and Technical Information of China (English)

    Corinna LUDWIG; Walburga ENGEL-RIEDEL; Erich STOELBEN

    2008-01-01

    Background and objective Sleeve resections were introduced to preserve lung function in patients with limited pulmonary reserve. Increasing experience with sleeve resection has reduced the rate of pneumonectomy below 10%. The aim of the study was to assess the outcome after neoadjuvant chemo- or chemoradiotherapy and sleeve resection in patients with N2 non-small cell lung cancer. Methods Retrospective analysis of 41 patient records between 01.01.2005 and 31.12.2007 underwent induction therapy in N2-disease followed by tracheobronchial sleeve resection.These patients were compared to the overall results after sleeve resection in our institution. Data analysed were; length of chest tube drainage in days, length of hospital stay, complications, morbidity and hospital mortality. Results In 178 patients, an anatomical bronchoplastic resection was performed. Preoperative chemotherapy in N2-disease (n=42) was given in 30 patients and radiochemotherapy in 11 patients. The length of the operation was between 94 min-493 rain (average 143 min). Chest tubes were removed on average after 5 days. Patients were discharged after 10 days. RO-resection was possible in 90%. The overall complication rate was 27% (11/41). The rate of bronchial anastovaotic leakage was 9.7% (4/41). Two patients with postoperative respiratory, insufficiency and mechanical ventilation, 1 patient with technical failure required early correction of the suture and .ne patient with a necrosis of the anastomosis. 30-day hospital mortality rate was 2.4% (1/41). Conclusion Sleeve resection after neoadjuvant therapy has a higher local morbidity (anastomotic insufficiency 9.7% vs 2.8%). This may be explained by the quality of the surrounding tissue after neoadjuvant therapy,which compromises healing of the anastomosis. However, the results are comparable to those without induction therapy in terms of radicality, and 30-d mortality rate (P>O.05). We therefore believe that sleeve resection after neoadjuvant therapy

  1. Morbidity and mortality after neoadjuvant therapy and sleeve lobectomyin N2-disease

    Directory of Open Access Journals (Sweden)

    Corinna LUDWIG

    2008-10-01

    Full Text Available Background and objective Sleeve resections were introduced to preserve lung function in patients with limited pulmonary reserve. Increasing experience with sleeve resection has reduced the rate of pneumonectomy below 10%. The aim of the study was to assess the outcome after neoadjuvant chemo- or chemoradiotherapy and sleeve resection in patients with N2 non-small cell lung cancer. Methods Retrospective analysis of 41 patient records between 01.01.2005 and 31.12.2007 underwent induction therapy in N2-disease followed by tracheobronchial sleeve resection. These patients were compared to the overall results after sleeve resection in our institution. Data analysed were; length of chest tube drainage in days, length of hospital stay, complications, morbidity and hospital mortality. Results In 178 patients, an anatomical bronchoplastic resection was performed. Preoperative chemotherapy in N2-disease (n =42 was given in 30 patients and radiochemotherapy in 11 patients. The length of the operation was between 94 min-493 min (average 143 min. Chest tubes were removed on average after 5 days. Patients were discharged after 10 days. R0-resection was possible in 90%. The overall complication rate was 27% (11/41. The rate of bronchial anastomotic leakage was 9.7%(4/41. Two patients with postoperative respiratory insufficiency and mechanical ventilation, 1 patient with technical failure required early correction of the suture and one patient with a necrosis of the anastomosis. 30-day hospital mortality rate was 2.4% (1/41. Conclusion Sleeve resection after neoadjuvant therapy has a higher local morbidity (anastomotic insufficiency 9.7% vs 2.8%. This may be explained by the quality of the surrounding tissue after neoadjuvant therapy, which compromises healing of the anastomosis. However, the results are comparable to those without induction therapy interms of radicality, and 30-d mortality rate (P >0.05. We therefore believe that sleeve resection after

  2. Heat Treatment Process of 20 Steel Drill Sleeve%20钢钻套热处理工艺

    Institute of Scientific and Technical Information of China (English)

    王道林

    2012-01-01

    According to the technical requirements of sleeve parts, 20 steel was chosen as the material of drill sleeve. The conventional heat treatment process of drill sleeve was improved, the new heat treatment process can short the time of heat treatment process, reduce the production cost, and greatly extend the working life of drilling sleeve.%根据钻套的技术要求,选用20钢作为钻套材料,对其常规热处理工艺进行改进,可缩短热处理工艺时间,降低生产成本,延长钻套的使用寿命.

  3. Can Robotic Gastrectomy Surpass Laparoscopic Gastrectomy by Acquiring Long-Term Experience? A Propensity Score Analysis of a 7-Year Experience at a Single Institution

    Science.gov (United States)

    Hong, Sung-Soo; Shin, Ho-Jung; Cui, Long-Hai; Hur, Hoon; Han, Sang-Uk

    2016-01-01

    Purpose It is hypothesized that robotic gastrectomy may surpass laparoscopic gastrectomy after the operators acquire long-term experience and skills in the manipulation of robotic arms. This study aimed to evaluate the long-term learning curve of robotic distal gastrectomy (RDG) for gastric cancer compared with laparoscopic distal gastrectomy (LDG). Materials and Methods From October 2008 to December 2015, patients who underwent LDG (n=809) were matched to patients who underwent RDG (n=232) at a 1:1 ratio, by using a propensity score matching method after stratification for the operative year. The surgical outcomes, such as trends of operative time, blood loss, and complication rate, were compared between the two groups. Results The RDG group showed a longer operative time (171.3 minutes vs. 147.6 minutes, P<0.001) but less estimated blood loss (77.6 ml vs. 116.6 ml, P<0.001). The complication rate and postoperative recovery did not differ between the two groups. The RDG group showed a longer operative time and similar estimated blood loss compared with the LDG group after 5 years of experience (operative time: 159.2 minutes vs. 136.0 minutes in 2015, P=0.003; estimated blood loss: 72.9 ml vs. 78.1 ml in 2015, P=0.793). Conclusions In terms of short-term surgical outcomes, RDG may not surpass LDG after a long-term experience with the technique. PMID:28053810

  4. Phaco-emulsification in completely vitrectomized eyes: Intraoperative analysis of modified phaco sleeve

    Directory of Open Access Journals (Sweden)

    Rajesh S Joshi

    2016-01-01

    Full Text Available Purpose: The purpose was to evaluate the results of modified sleeve in phacoemulsification of cataract in completely vitrectomised eyes, Materials and Methods: Twenty-five previously completely vitrectomized eyes of 23 patients having visually significant cataract were included. After through evaluation they underwent phaco-emulsification by phaco chop with a modified sleeve via temporal clear corneal incision. The modified sleeve was made by creating a small round port of approximate 1 × 1 mm size at the proximate end of the sleeve in line with the already existing ports. This port faced the posterior capsule while performing phacoemulsification. Patients were observed for any intraoperative complications. Result: The most common indication for pars plana vitrectomy in our study group was vitreous hemorrhage due to diabetic retinopathy [13 out of 25 eyes (52%]. Intraoperative findings included miosis [seen in 3 (12% eyes] and posterior capsular plaque [seen in 2(8% eyes]. No other significant intraoperative complications (posterior capsular tear, dropped nucleus were observed. Average effective phaco time was 33 sec. (±15.11. Conclusion: Though cataract surgery in postvitrectomized eyes is a challenging situation, modified sleeve prevents anterior chamber fluctuation and avoids complications arising out of it, making the surgery safe.

  5. Three cases of laparoscopic total gastrectomy with intracorporeal esophagojejunostomy for gastric cancer in remnant stomach.

    Science.gov (United States)

    Pan, Yu; Mou, Yi-Ping; Chen, Ke; Xu, Xiao-Wu; Cai, Jia-Qin; Wu, Di; Zhou, Yu-Cheng

    2014-11-13

    Gastric cancer in remnant stomach is a rare tumor but with poor prognosis. Compared with conventional open surgery, laparoscopic gastrectomy has potential benefits for these patients due to advantages resulting from its minimally invasive approach. Herein, we report on three patients with gastric cancer in remnant stomach who underwent laparoscopic total gastrectomy with intracorporeal esophagojejunostomy successfully. The operative time was 280, 250 and 225 minutes, the estimated blood loss was 100, 80 and 50 ml and the length of postoperative hospital stay was seven, eight and nine days respectively. Our experience has suggested that laparoscopic total gastrectomy with intracorporeal esophagojejunostomy can be a safe, feasible and promising option for patients with gastric cancer in remnant stomach.

  6. Secondary omental infarction related to open and laparoscopic-assisted distal gastrectomy: report of two cases.

    Science.gov (United States)

    Park, Kyung Eun; Chung, Dong Jin; Kim, Wook; Hahn, Seong-Tae; Lee, Jae Moon

    2011-01-01

    Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.

  7. Post-gastrectomy patients need to be followed up for 20-30 years

    Institute of Scientific and Technical Information of China (English)

    Frank I. Tovey; Michael Hobsley

    2000-01-01

    AIM To investigate the incidence andmanagement of nutritional deficiencies followinga gastrectomy.METHODS A gastrectomy population of 227patients in London was followed up for 30 years after operation to detect and treat nutritional deficiencies.RESULTS By the end of the first decade iron deficiency was the commonest problem. Vitamin B12 deficiency became more important in the second decade. During the third decade both reached equal prevalence, being found in some 90% of the female and 70% of the male residual population. Vitamin D deficiency was a lesser problem, reaching its climax in the second decade. Overall, all women fared worse than men.CONCLUSION The importance of long-term follow-up of gastrectomy patients for iron,Vitamin B12 and Vitamin D deficiencies is emphasised.

  8. Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer

    Science.gov (United States)

    Lin, Mong-Wei; Kuo, Shuenn-Wen; Yang, Shun-Mao

    2016-01-01

    Background The Da Vinci robotic system has been used to enhance the surgeon’s visualization and agility in lung cancer surgery, and thus facilitate refined dissection, knot tying and suturing. However, only a few case reports exist on performing a sleeve lobectomy with a robotic-assisted thoracoscopic surgery (RATS) technique. Here we describe our early experience performing RATS sleeve lobectomies. To our knowledge, this is the first study reporting a series of RATS sleeve lobectomies. Methods The six consecutive NSCLC patients who underwent a RATS sleeve lobectomy between November 2013 and July 2015 at the National Taiwan University Hospital were enrolled in this study. The lobectomies were all performed by the same surgeon using a three-arm robotic system with an additional utility incision made for assistance and specimen retrieval. Results Five patients were diagnosed with squamous cell carcinoma, while the sixth was diagnosed with a carcinoid tumor. The mean operation time was 436.7 [255–745] minutes. The mean postoperative intensive care unit (ICU) stay and hospital stay were 3.7 [1–11] and 11.3 [3–26] days, respectively. Two (33.3%; 2/6) morbidities were noted, including one pneumonia and one anastomosis stricture. There were no cases of mortality or of conversion to thoracotomy. Conclusions Our experience performing a RATS sleeve lobectomy in the six patients demonstrated the feasibility of RATS in complex lung cancer surgeries. The three-dimensional vision and articulated joint instruments made robotic-assisted bronchial anastomosis easier under the endoscopic setting. Our experience suggests that RATS offers specific advantages with regard to accuracy and safety when performing sleeve lobectomies. PMID:27499965

  9. EVALUATION OF N-RATIO IN SELECTING PATIENTS FOR ADJUVANT CHEMORADIOTHERAPY AFTER D2-GASTRECTOMY

    Directory of Open Access Journals (Sweden)

    Wilson Luiz da COSTA JUNIOR

    2013-12-01

    Full Text Available Context Whether adjuvant chemoradiotherapy may contribute to improve survival outcomes after D2-gastrectomy remains controvertial. Objective To explore the clinical utility of N-Ratio in selecting gastric cancer patients for adjuvant chemoradiotherapy after D2-gastrectomy. Methods A retrospective cohort study was carried out on gastric cancer patients who underwent D2-gastrectomy alone or D2-gastrectomy plus adjuvant chemoradiotherapy (INT-0116 protocol at the Hospital A. C. Camargo from September 1998 to December 2008. Statistical analysis were performed using multiple conventional methods, such as c-statistic, adjusted Cox's regression and stratified survival analysis. Results Our analysis involved 128 patients. According to c-statistic, the N-Ratio (i.e., as a continuous variable presented “area under ROC curve” (AUC of 0.713, while the number of metastatic nodes presented AUC of 0.705. After categorization, the cut-offs provide by Marchet et al. displayed the highest discriminating power – AUC value of 0.702. This N-Ratio categorization was confirmed as an independent predictor of survival using multivariate analyses. There also was a trend of better survival by adding of adjuvant chemoradiotherapy only for patients with milder degrees of lymphatic spread – 5-year survival of 23.1% vs 66.9%, respectively (HR = 0.426, 95% CI 0.150–1.202; P = 0.092. Conclusions This study confirms the N-Ratio as a tool to improve the lymph node metastasis staging in gastric cancer and suggests the cut-offs provided by Marchet et al. as the best way for its categorization after a D2-gastrectomy. In these settings, the N-Ratio appears a useful tool to select patients for adjuvant chemoradiotherapy, and the benefit of adding this type of adjuvancy to D2-gastrectomy is suggested to be limited to patients with milder degrees of lymphatic spread (i.e., NR2, 10%–25%.

  10. Comparative Study on the Difference in Functional Outcomes at Discharge between Proximal and Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Kazuaki Kuwabara

    2012-06-01

    Full Text Available Several studies have regarded proximal gastrectomy (PG as optimal compared to total gastrectomy (TG for upper stomach cancer. In addition to the traditional outcomes of complication and mortality, change in functional status should be considered as another relevant outcome in aging generations. However, there has been no community-based appraisal of functional outcomes between PG and TG. Using an administrative database, we compared functional outcomes between PG and TG. Among 12,508 patients who survived for ≥15 years and underwent open gastrectomy between 2008 and 2010, we examined patient characteristics, comorbidities, functional status estimated by the Barthel index (BI at admission and discharge, complications, ICU care, ventilation administration, blood transfusion, operating room time, resumption of oral intake, length of stay and total charges. With reference to distal gastrectomy (DG, we performed multivariate analyses to assess the impacts of PG and TG on complications and BI deterioration. A total of 434 PGs and 4,941 TGs were observed in 148 and 295 hospitals, respectively. Patient characteristics, care process, resumption of oral intake, operating room time, length of stay and total charges were also significantly different among the three gastrectomy types. PG, TG and DG were not associated with complications or functional deterioration. Patient characteristics, preoperative blood transfusion and longer operating room time were significantly associated with more complications and BI deterioration. Since patient case mix and longer operating room time were associated with poor outcomes, physicians should recognize the role of PG and might optimally challenge and complete gastrectomies within the appropriate indications.

  11. Numerical Simulation and Experimental Validation of an Integrated Sleeve-Wedge Anchorage for CFRP Rods

    DEFF Research Database (Denmark)

    Schmidt, Jacob Wittrup; Smith, Scott T.; Täljsten, Björn;

    2011-01-01

    . Recently, an integrated sleeve-wedge anchorage has been successfully developed specifically for CFRP rods. This paper in turn presents a numerical simulation of the newly developed anchorage using ABAQUS. The three-dimensional finite element (FE) model, which considers material non-linearity, uses...... hexagonal elements for the barrel and CFRP rod and tetrahedral elements for the integrated sleeve-wedge. The simulated barrel surface strains are shown to compare well with optically measured strains, however, the numerical results are shown to be sensitive to the mechanical properties of the anchorage...

  12. Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To investigate the prognostic impact of metastatic lymph node ratio(rN) on gastric cancer after curative distal gastrectomy.METHODS:A total of 634 gastric cancer patients who underwent curative resection(R0) of lymph nodes at distal gastrectomy in 1995-2004.Correlations between positive nodes and retrieved nodes,between rN and retrieved nodes,and between rN and negative lymph node(LN) count were analyzed respectively.Prognostic factors were identif ied by univariate and multivariate analyses.Staging acc...

  13. Totally laparoscopic gastrectomy for early gastric cancer accompanied by huge hiatal hernia: A case report.

    Science.gov (United States)

    Hagiwara, Chie; Yajima, Kazuhito; Iwasaki, Yoshiaki; Oohinata, Ryouki; Yuu, Ken; Ishiyama, Satoshi; Amaki, Misato; Nakano, Daisuke; Yamaguchi, Tatsuro; Matsumoto, Hiroshi; Takahashi, Keiichi

    2016-02-01

    We herein present a case in which we used a totally laparoscopic approach for early gastric cancer accompanied by a huge hiatal hernia. An 80-year-old Japanese woman was referred with a chief complaint of dysphagia. A clinical diagnosis of early gastric cancer, T1b (SM) N0M0, stage IA, accompanied by hiatal hernia, was made. Distal gastrectomy with D1 plus lymphadenectomy was carried out. After the gastrectomy, the hernial sac was excised and the hernial orifice was closed. Reconstruction using the Roux-en-Y method was selected. The postoperative course was uneventful and she was discharged on postoperative day 10.

  14. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  15. Rotor losses in laminated magnets and an anisotropic carbon fiber sleeve

    NARCIS (Netherlands)

    Van der Geest, M.; Wolmarans, J.J.; Polinder, H.; Ferreira, J.A.; Zeilstra, D.

    2012-01-01

    High speed fault tolerant permanent magnet machines have strong asynchronous airgap harmonics, making them susceptible to rotor eddy-current losses. These losses can be reduced by using novel high resistivity materials like plastic bonded magnets and carbon fiber reinforced retaining sleeves. This p

  16. Endoscopic sleeve gastroplasty (the Apollo method: a new approach to obesity management

    Directory of Open Access Journals (Sweden)

    Gontrand López-Nava-Breviere

    2016-04-01

    Full Text Available Background: Many obese patients cannot lose weight or reject conventional obesity management. Endoscopic sleeve gastroplasty (the Apollo method is a pioneering coadjuvant, interventionist technique for the integral management of obesity. Objectives: The goals of this study were to report safety and efficacy results obtained at 6 months in patients undergoing endoscopic sleeve gastroplasty. Material and methods: A prospective study was performed in 55 patients (13 males, 42 females who were subjected to the Apollo technique; mean age was 43.5 years (range 25-60 and mean BMI was 37.7 kg/m² (range 30-48. All received multidisciplinary follow-up for weight loss. Weight changes and presence of complications were assessed. Through the endoscope a triangular pattern suture is performed consisting of approximately 3-6 transmural (mucosa to serosa stitches, using a cinch device to bring them nearer and form a plication. Results: A total of 6-8 plications are used to provide a tubular or sleeve-shaped restriction to the gastric cavity. No major complications developed and patients were discharged at 24 hours following the procedure. Endoscopic and radiographic follow-up at 6 months post-procedure showed a well preserved tubular form to the stomach. After 6 months patients had lost 18.9 kg and 55.3% of excess weight. Conclusions: Endoscopic sleeve gastroplasty, together with dietary and psycho-behavioral changes, is a safe, effective technique in the coadjuvant management of obese patients.

  17. Concept for sleeve induction motor with 1-msec mechanical time constant

    Science.gov (United States)

    Wiegand, D. E.

    1968-01-01

    Conductive sleeve induction motor having a 1-msec mechanical time constant is used with solid-state devices to control all-electric servo power systems. The servomotor rotor inertia is small compared to the maximum force rating of the servo motion, permitting high no-load acceleration.

  18. Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections†.

    Science.gov (United States)

    Gonzalez-Rivas, Diego; Yang, Yang; Stupnik, Tomaz; Sekhniaidze, Dmitrii; Fernandez, Ricardo; Velasco, Carlos; Zhu, Yuming; Jiang, Gening

    2016-01-01

    Locally advanced lung tumours often require complex surgical techniques to achieve an oncological and safe procedure. Sleeve resections when operating on endobronchial lesions or hilar tumours should be attempted whenever possible rather than performing a pneumonectomy. These procedures result in improved survival, better quality of life, a reduced loss of lung function and an improved operative mortality compared with pneumonectomy. Although the most common approach is an open thoracotomy, these complex surgical techniques can be performed in a thoracoscopic way with the skills and the experience gained from major video-assisted thoracoscopic procedures (VATS). However, despite the multiple advantages of VATS compared with thoracotomy, such as decreased postoperative pain and better recovery, this minimally invasive approach is still not widely adopted for advanced stages of lung cancer and complex resections. Concerns about performing an adequate oncological resection and safe reconstruction VATS are the main reasons for the low adoption of these minimally invasive approaches. Like other thoracoscopic techniques, VATS sleeve procedures also have a steep learning curve, and should therefore be performed either by or with skilled and experienced VATS surgeons to ensure safety and avoid complications. In this article, we describe the technique of thoracoscopic sleeve procedures through a single-incision (uniportal) approach for bronchial, bronchovascular, tracheal and carinal reconstruction, and review the literature reporting sleeve resections by VATS.

  19. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a nov...

  20. DEVISING THE UP-TO-DATE METHOD PATTERN MAKING OF FEMALE APPAREL WITH RAGLAN SLEEVE

    Institute of Scientific and Technical Information of China (English)

    Li Yue; V.E. Kuzmichev; E. Sablina

    2004-01-01

    This article aimed to find a new way to transform the graphic image (drawing, photos, etc) to the pattern parameters of female apparel with raglan sleeve. The correlation and regressive analysis were used to the data in order to find the existing laws between them. The practical examinations demonstrated the good predictability of equations established.

  1. Risk factors for hospital readmission after radical gastrectomy for gastric cancer:a prospective study

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:hTe purpose of this prospective study was to determine risk factors for readmission within 30 days of discharge after gastrectomy for patients with gastric cancer.Methods: We conducted a prospective study of patients undergoing radical gastrectomy for gastric cancer from October 2013 to November 2014 in our institution. hTe incidence, cause and risk factors for 30-day readmission were determined.Results:A total of 376 patients were included in our analysis without loss in follow-up. hTe 30-day readmission rate after radical gastrectomy for gastric cancer was 7.2% (27 of 376). The most common cause for readmission included gastrointestinal complications and postoperative infections. On the basis of multivariate logistic regression analysis, preoperative nutritional risk screening 2002 score ≥ 3 was an independent risk factor for 30-day readmission. Conclusion:Readmission within 30 days of discharge atfer radical gastrectomy for gastric cancer is common. Patients with nutritional risk preoperatively are at high risk for 30-day readmission.

  2. Effect of a neoprene sleeve on knee joint position sense during sitting open kinetic chain and supine closed kinetic chain tests.

    Science.gov (United States)

    Birmingham, T B; Kramer, J F; Inglis, J T; Mooney, C A; Murray, L J; Fowler, P J; Kirkley, S

    1998-01-01

    The primary objective of the present study was to compare the effect of a neoprene sleeve on knee joint position sense during a sitting open kinetic chain test and a supine closed kinetic chain test. Young (24 +/- 2 years old), healthy subjects (18 men and 18 women) performed knee joint angle replication tests during open kinetic chain knee extension (sitting) and closed kinetic chain leg press (supine with an axial load of 15% body weight) before and after application of a neoprene sleeve over the dominant knee. The improvement in ability to replicate joint angles after application of the sleeve (sleeve effect) was significantly less during the supine closed kinetic chain test (0.3 degree +/- 1.4 degrees) than during the sitting open kinetic chain test (1.2 degrees +/- 1.1 degrees). The sleeve effect was inversely related to subjects' performance without the sleeve during both the sitting open kinetic chain and supine closed kinetic chain tests, suggesting that some people may derive greater benefit from the sleeve than others. Although the sleeve effects were small, particularly during the supine closed kinetic chain test, 72% of subjects felt that the sleeve improved their overall test performance. Future research is needed to establish the functional relevance of the small sleeve effects observed and to identify the characteristics of people who might derive greatest benefit from sleeve use.

  3. Effects of total gastrectomy on plasma silicon and amino acid concentrations in men.

    Science.gov (United States)

    Tatara, Marcin R; Krupski, Witold; Szpetnar, Maria; Dąbrowski, Andrzej; Bury, Paweł; Szabelska, Anna; Charuta, Anna; Boguszewska-Czubara, Anna; Maciejewski, Ryszard; Wallner, Grzegorz

    2015-12-01

    The aim of the study was to determine one-year effects of total gastrectomy on plasma silicon and free amino acid concentrations in patients and evaluate changes of volumetric bone mineral density (vBMD) in lumbar spine. Eight patients were enrolled to the control (CTR) group. Six patients subjected to total gastrectomy (GX group) were included to the experimental group. vBMD in trabecular and cortical bone was measured in lumbar vertebrae at baseline (before surgery) and one year later using quantitative computed tomography. Plasma concentrations of silicon and free amino acids were determined at baseline and one year later using photometric method and ion-exchange chromatography. Body weights within CTR and GX groups were not different after one-year follow-up when compared to the baseline values (P > 0.05). An average annual decrease of vBMD in the trabecular bone in the gastrectomized patients reached 15.0% in lumbar spine and was significantly different in comparison to the percentage changes observed in CTR group (P = 0.02). One-year percentage change of vBMD in the cortical bone in L1 and L2 has shown significantly decreased values by 10.5 and 9.1% in the GX group when compared to the percentage change observed in the controls (P silicon was significantly lowered by 26.7% one year after the total gastrectomy when compared to the baseline value (P = 0.009). Total gastrectomy in patients has induced severe osteoporotic changes in lumbar spine within one-year period. The observed osteoporotic changes were associated with decreased plasma concentration of silicon indicating importance of exocrine and endocrine functions of stomach for silicon homeostasis maintenance. Gastrectomy-induced bone loss was not related to decreased amino acid concentration in plasma obtained from overnight fasted patients.

  4. Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection

    Institute of Scientific and Technical Information of China (English)

    Jun Ho Lee; Junuk Kim; Jae Ho Cheong; Woo Jin Hyung; Seung Ho Choi; Sung Hoon Noh

    2005-01-01

    AIM: To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis.METHODS: A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis.RESULTS: All but 12 patients were classified as Child's class A. Only 35 patients (37.2%) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7%) and 21 patients (22.3%)underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8%) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4%) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P = 0.011) and transfusion did (P= 0.008). The most common postoperative complication was ascites (13.9%) followed by wound infection (10.6%).CONCLUSION: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

  5. Anticorrosive field joint coating qualification, heat shrinkable sleeve; Qualificacao de revestimento anticorrosivo para juntas de campo, mantas termocontrateis

    Energy Technology Data Exchange (ETDEWEB)

    Cabral, Glaucia B.; Koebsch, Andre; Castinheiras Junior, Wilson [PETROBRAS, Rio de Janeiro, RJ (Brazil)

    2005-07-01

    The main objective of this job is to present the quality requirements fixed by PETROBRAS for anticorrosive field joint coating for buried pipelines, industrially coated with PE-3L. It describes the used system - polyethylene based heat shrinkable sleeve - comparing with the existent on the pipeline. So, it exposes the suppliers' qualification stages, which include test carried out for the materials, for the sleeve set and for the coating after its application on the joint field. Finally, it shows that the experience, which has been gotten in the qualification, consolidated the quality control systematic that have been carry out during the sleeves acquisition and application at the pipeline construction. (author)

  6. Surgical Outcomes and Local Recurrence Following Total or Subtotal Gastrectomy for Early Adenocarcinoma of Antrum

    Institute of Scientific and Technical Information of China (English)

    Mehrdad Moghimi; Seyed Ali Marashi; Taghi Salehian; Habibollah Peirovi; Faezeh Sodagari

    2008-01-01

    Objective:The choice between total gastrectomy(TG)and subtotal gastrectomy(STG)for early adenocarcinoma of the lower third of the stomach is still a matter of debate and controversy amongst surgeons.The aim of this study was to compare the surgical outcomes,quality of life(QoL),and local recurrence rates as well as other results of curative resection of early distal adenocarcinoma of the stomach using TG or STG performed in Iran. Methods:Hospital records of 66 patients with early distal adenocarcinoma of stomach that underwent even total or subtotal gastrectomy with perigastric(D2)lymphadenectomy between October 2001 and February 2006 in Taleghani Hospital,Iran were reviewed retrospectively.Demographic data as well as clinicopathological factors including number of involved lymph nodes,tumor grading,depth of invation,tumor size,and tumor type were recorded.Post-operative outcomes including mortality and morbidity,tumor recurrence and quality of life were assessed.Univariate analyses using Fisher's exact test,the Student t-test,and the Pearson X2 test were used. Results:Local recurrence of tumor was found in 8(23%)TG group patients and in 19(61%)patients of STG group.the Pearson X2 test showed a significant higher recurrence rate in STG(P value=0.002,Relative Risk=2.68,Confidence Interval:1.37-5.24).The mean time interval between gastrectomy and tumor recurrence was not different between TG and STG.(19.75±5.1 vs.18.0±7.8 respectively;P value=0.507)Tumor size>5 cm(P value=0.004),diffuse type(P value=0.034),poor differentiation(P value=0.000)and serosal invasion(P value=0.012)were found to be significantly related to tumor recurrence in patients undergone gastrectomy.In none of the QoL measures a significant difference was found between TG and STG. Conclusion:Our results show that subtotal and total gastrectomy methods with perigastric lymphadenectomy have a similar postoperative complication rate and surgical outcomes as well as patient's QoL but STG was

  7. D2 dissection in laparoscopic and open gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Ming Cui; Jia-Di Xing; Wei Yang; Yi-Yuan Ma; Zhen-Dan Yao; Nan Zhang; Xiang-Qian Su

    2012-01-01

    AIM:To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer.METHODS:Clinicopathological data from 209 patients with gastric cancer,who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011,were analyzed retrospectively.Among these patients,131 patients underwent laparoscopyassisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG).The parameters analyzed included operative time,blood loss,blood transfusion,morbidity,mortality,the number of harvested lymph nodes (HLNs),and pathological stage.RESULTS:There were no significant differences in sex,age,types of radical resection [radical proximal gastrectomy (PG + D2),radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)],and stages between the LAG and OG groups (P > 0.05).Among the two groups,127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs,respectively.The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P =0.233).In the same type of radical resection,there were no significant differences in the number of HLNs between the two groups (PG + D2:21.7 ± 7.5 vs 22.4 4-9.3;DG + D2:25.7 ± 11.0 vs 22.3 ± 7.9; TG + D2:30.9 ± 13.4 vs 29.3 ± 10.4; P > 0.05 for all comparisons).Tumor free margins were obtained in all cases.Compared with OG group,the LAG group had significantly less blood loss,but a longer operation time (P < 0.001).The morbidity of the LAG group was 9.9%,which was not significantly different from the OG group (7.7%) (P=0.587).The mortality was zero in both groups.CONCLUSION:Laparoscopic D2 dissection is equivalent to OG in the number of HLNs,regardless of tumor location.Thus,this procedure can achieve the same radicalness as OG.

  8. A kinetic and kinematic analysis of the effect of stochastic resonance electrical stimulation and knee sleeve during gait in osteoarthritis of the knee.

    Science.gov (United States)

    Collins, Amber; Blackburn, Troy; Olcott, Chris; Jordan, Joanne M; Yu, Bing; Weinhold, Paul

    2014-02-01

    Extended use of knee sleeves in populations at risk for knee osteoarthritis progression has shown functional and quality of life benefits; however, additional comprehensive kinematic and kinetic analyses are needed to determine possible physical mechanisms of these benefits which may be due to the sleeve's ability to enhance knee proprioception. A novel means of extending these enhancements may be through stochastic resonance stimulation. Our goal was to determine whether the use of a knee sleeve alone or combined with stochastic resonance electrical stimulation improves knee mechanics in knee osteoarthritis. Gait kinetics and kinematics were assessed in subjects with medial knee osteoarthritis when presented with four conditions: control1, no electrical stimulation/sleeve, 75% threshold stimulation/sleeve, and control2. An increase in knee flexion angle throughout stance and a decrease in flexion moment occurring immediately after initial contact were seen in the stimulation/sleeve and sleeve alone conditions; however, these treatment conditions did not affect the knee adduction angle and internal knee abduction moment during weight acceptance. No differences were found between the sleeve alone and the stochastic resonance with sleeve conditions. A knee sleeve can improve sagittal-plane knee kinematics and kinetics, although adding the current configuration of stochastic resonance did not enhance these effects.

  9. Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives

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    Aman Jyoti

    2014-01-01

    Full Text Available The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB. Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.

  10. Conspray dynamic sleeve piston coal feeder. Phase II. Verification tests. Final technical report

    Energy Technology Data Exchange (ETDEWEB)

    1984-01-26

    This report details the performance of Phase II: Verification Tests of the Conspray dynamic sleeve piston coal feeder. The machine performed for 200 hours at 700 psi backpressure, utilizing a 70% to 200 mesh Utah bituminous coal as feedstock. All test work was satisfactorily completed. A post-test inspection was performed. A report of component wear and failures incurred in testing is included as well as suggestions for machine upgrades. The overall conclusion is that the dynamic sleeve piston feeder has proven its ability to operate safely and reliably. When problems have occurred, the machine has demonstrated inherent safety by shutting down without endangering process or personnel. With the recommended improvements incorporated into the feeder, the unit will be ready for installation on a pilot scale coal gasifier. 9 figures, 11 tables.

  11. DURABILITY-RELATED CHARACTERISTICS OF DOUBLE-LAYER STRUCTURES OF PIPELINES CONNECTED TO POLYMERIC SLEEVES

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    Orlov Vladimir Alexandrovich

    2012-10-01

    The ultimate objective of the software programme is to assess the applicability of the trenchless repair method involving a polymeric sleeve in each specific case by taking account of the environment and the condition of the pipeline. The software is also capable of developing the requirements to be fulfilled by subcontractors in order to assure the appropriate quality of any repair work performed and the reliability of any pipeline sections repaired.

  12. Two-incision approach for video-assisted thoracoscopic sleeve lobectomy.

    Science.gov (United States)

    Peña, Emilio; Blanco, Montserrat; Ovalle, Juan Pablo

    2014-03-01

    The video-assisted thoracoscopic approach for bronchoplasty procedures is not standardized. Although 3 to 4 incisions are usually made, with adequate surgical technique, the operation can be successfully carried out using only 2 incisions. We describe the technique of video-assisted thoracoscopic surgery for a right upper lobe sleeve lobectomy for a carcinoid tumor in the right upper bronchus, using only 2 ports.

  13. The effect of a neoprene sleeve on knee joint position sense.

    Science.gov (United States)

    Herrington, Lee; Simmonds, Claire; Hatcher, Julian

    2005-01-01

    The aims of the study were, first, to assess the effect of a neoprene knee brace on prop rioceptive acuity of normal subjects and, second, to assess the relationships between a variety of tests of proprioceptive acuity. Twenty healthy, physically active subjects had absolute error scores measured while carrying out three different established tests of proprioceptive ability (active tracking, active reproduction, and perceived angle tests) under two conditions, either with or without the presence of a neoprene sleeve. The neoprene sleeve significanltly improved the degree of error scores in all tests. For the active tracking, test accuracy was improved by 28% (p = 0.004), the angle reproduction test showed a 23% increase in accuracy (p = 0.029), and the accurancy of the perceived angle test improved by 27% (p = 0.035). The relationship between magnitude of error scores between the test all showed nonsignificant low correlation. The findings of this study support the previous literature, which indicates that the application of a knee sleeve improves proprioceptive acuity. The study also indicates that when testing proprioceptive acuity, a test battery should be used because of the limited correlatiotn between any of the tests used.

  14. Anemia after gastrectomy for early gastric cancer:Long-term follow-up observational study

    Institute of Scientific and Technical Information of China (English)

    Chul-Hyun Lim; Sang Woo Kim; Won Chul Kim; Jin Soo Kim; Yu Kyung Cho; Jae Myung Park; In Seok Lee

    2012-01-01

    AIM:To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer.METHODS:The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed.Patients with anemia in the preoperative workup,cancer recurrence,undergoing systemic chemotherapy,with other medical conditions that can cause anemia,or treated during follow up with red cell transfusions or supplements for anemia were excluded.Anemia was defined by World Health Organization criteria (Hb < 12 g/dL in women and <13 g/dL in men).Iron deficiency was defined as serum ferritin < 20 μg/dL.Vitamin B12 deficiency was defined as serum vitamin B12 < 200 pg/mL.Iron deficiency anemia was defined as anemia with concomitant iron deficiency.Anemia from vitamin B12 deficiency was defined as megaloblastic anemia (mean cell volume >100 fL) with vitamin B12 deficiency.The profile of anemia over 48 mo of follow-up was analyzed.RESULTS:One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed.The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery.The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery.Anemia of chronic disease and megaloblastic anemia were uncommon.The incidence of anemia in female patients was significantly higher than in male patients at 12 (40.0% vs 22.0%,P =0.033),24 (45.0% vs 25.0%,P =0.023),36 (55.0%vs 28.0%,P =0.004),and 48 mo (52.0% vs 31.0%,P =0.022) after surgery.Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery (60.7% vs 31.3%,P =0.008).The incidence of iron deficiency was significantly higher in female patients than in male patients at 6 (35.4% vs

  15. [A case of pancreatic and duodenal fistula after total gastrectomy successfully treated with coagulation factor XIII].

    Science.gov (United States)

    Nishino, Hitoe; Kojima, Kazuhiro; Oshima, Hirokazu; Nakagawa, Koji; Fumura, Masao; Kikuchi, Norio

    2013-11-01

    Pancreatic fistula( PF) is a challenging postoperative complication. We report a case of PF following gastrectomy successfully treated using intravenous coagulation factor XIII( FXIII).A 78-year-old man with early gastric cancer underwent total gastrectomy with Roux-en-Y reconstruction. PF developed postoperatively, following which, leakage from the duodenal stump was observed. Percutaneous drainage and re-operative surgery were performed. A somatostatin analogue, antibiotic drugs, and gabexate mesilate were administrated along with nutritional support. The pancreatic and duodenal fistula had been producing duodenal juice for over 30 days since the re-operative surgery. As suspected, reduced FXIII activity was confirmed in the patient. After administering FXIII for 5 days, the amount of duodenal juice from the fistula markedly reduced, and the fistula closed immediately afterwards. The results of our study suggest that administration of FXIII could be a reasonable and effective treatment for patients with pancreatic or/and enterocutaneous fistula who are resistant to standard treatments.

  16. Transient appearance of postoperative EDTA-dependent pseudothrombocytopenia in a patient after gastrectomy.

    Science.gov (United States)

    Wenzel, Folker; Lasshofer, Roland; Rox, Jutta; Fischer, Johannes; Giers, Günther

    2011-01-01

    Ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia (EDTA-PTCP) is a well known phenomenon. Antiplatelet antibodies cause platelet clumping in EDTA anticoagulated blood samples, and blood count analysers calculate a spurious low platelet count. We describe a case of a transient appearance of EDTA-PTCP in a patient after gastrectomy. A 58-year-old man underwent partial gastrectomy in for gastric cancer. Preoperatively, his platelet count was in a normal range, and the surgical procedure was performed without bleeding complications. At day 10 after surgery the patient showed a low platelet count, which could be identified as EDTA-PTCP. The phenomenon disappeared in a following postoperative time interval of 2 months. In cases of recently occurring thrombocytopenias EDTA-PTCP should always be considered as a possible cause of low platelet count, in particular in cases of inconspicuous clinical findings. Appropriate laboratory analysis should be applied.

  17. Hiatal hernia following total gastrectomy with Roux-en-Y reconstruction.

    Science.gov (United States)

    Murata, S; Yamazaki, M; Kosugi, C; Hirano, A; Yoshimura, Y; Shiragami, R; Suzuki, M; Shuto, K; Koda, K

    2014-01-01

    Hiatal hernias after total gastrectomy for advanced gastric cancer are very rare. We review a case of a 44-year-old male who presented with dyspnea and chest pain 2 days after total gastrectomy, lower esophagectomy, and splenectomy with retrocolic Roux-en-Y reconstruction approached by a left thoracoabdominal incision for gastric cancer at the cardia. Plain and cross-sectional imaging identified a large hiatal hernia protruding into the right thorax containing left-sided transverse colon and small intestine. Our patient underwent a laparotomy, and after hernia reduction the hiatal defect was repaired by direct suturing. He experienced anastomotic leakage and right pyothorax, but recovered. The potential cause is discussed here and the published literature on this rare complication is reviewed briefly.

  18. Anterograde jejunojejunal intussusception resulted in acute efferent loop syndrome after subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Jung; Myun; Kwak; Jin; Kim; Sung; Ock; Suh

    2010-01-01

    Postoperative intussusception is an unusual clinical entity in adults,and is rarely encountered as a complication following gastric surgery.The most common type after gastric surgery is retrograde jejunogastric intussusception,and jejunojejunal intussusception has been rarely reported.We report a case of anterograde jejunojejunal intussusception after radical subtotal gastrectomy with Billroth Ⅱ anastomosis in a 38-year-old Korean woman with early gastric cancer,and include a review of the literature on thi...

  19. Evaluation of the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients

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    Chamanzari Hamid

    2016-08-01

    Full Text Available Background and Objective: The optimal treatment strategy for patients with gastric cancer is gastrectomy. Typically, nasogastric intubation is used after this type of surgery to feed patients; however, there seems to be no unanimity of opinion on this topic. Therefore, this study aimed to evaluate the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients. Materials and Method: This clinical trial was conducted on gastric cancer patients, admitted to the general ward of Imam Reza Hospital in Mashhad, Iran in 2015. In total, 68 patients were selected through randomized convenience sampling and divided into two intervention and control groups of 34 individuals. Nasogastric tube insertion was applied for the intervention group after the surgery. Patients of the study groups were fasted for three days after the surgery, which was followed by the removal of nasogastric tubes and initiation of oral feeding. Gastrointestinal function of all the participants was evaluated six hours after transferring to the ward up to seven days after the surgery on a daily basis using nausea and vomiting assessment tools and researcher-made questionnaire of gastrointestinal function. Data analysis was performed in SPSS version 16 using Fisher’s exact test, Chi-square, Mann-Whitney U, repeated measures ANOVA and paired t-test. Results: In this study, the severity of nausea and vomiting, the first time of passing gas and severity of flatulence Intensity were less observed in the control group, compared to the intervention group. Moreover, postoperative food tolerance was higher in the patients of the control group, compared to the other study group (P<0.05. Conclusion: According to the results of this study, nasogastric intubation can delay normal gastrointestinal function after gastrectomy. Therefore, it is not recommended to use this method after gastrectomy.

  20. The Application of FJI and Its Comparison with Different Alimentary Reconstructions after Total Gastrectomy for Cances

    Institute of Scientific and Technical Information of China (English)

    HAOXishan; LIQiang; 等

    2002-01-01

    Objective To investigate the optimum reconstruction after total gastrectomy for malignant disease,especially the necessity of gastric substitute and duodenal passage.Methods Among the 459 total gastrectomy cases,6 kinds of reconstructions had been used,including Braun,modified Braun I(mBraun I),modified Braun Ⅱ(mBraun Ⅱ),Roux-en-Y,“P jejunal interposition(PJI)and functional jejunal interposition(FJI).Postoperative complains,body weight,food intake,serum nutritional paraments,complete blood cout,half-emptying time of the gastric substitute,PNI,Visick index were evaluated one year after r surgery.Results As compared with Braun group,the mBraun I,Ⅱ and Roux-en-Y groups which had some kinds of gastric substitute showed less reflux esophagitis and higher serum total protein(P<0.01).As compared with mBraun I,Ⅱ,Roux-en-Y,PJI and FJI groups which had duodenal passage showed better body weight,higher nutritional paraments and PNI(P<0.05).Conclusion It is essential to construct a gastric substitute and maintain the food chyme flowing through the duodenum after total gastrectomy,and the FJI is a better choice in this study.

  1. Comparison of peritoneal free gastric cancer cells' detecting rates between laparoscopically assisted and open radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To compare laparoscopic gastrectomy and conventional surgery on the dissemination and seeding of tumor cells. Methods:Intraoperative peritoneal lavage cytologic examination was performed in 65 patients with gastric cancer, during laparoscopic gastrectomy (n=34) and conventional surgery (n=31). Cytology was examined twice, immediately after opening the peritoneal cavity and just before closing the abdomen. Saline was poured into the peritoneal cavity, and 100 ml fluid was retrieved after irrigation. Laparoscopic instruments were lavaged after surgery with 100 ml saline. Carbon dioxide (CO2) was derived through the trocar side orifice after pneumoperitoneum during laparoscopic gastrectomy and filtered through 100 ml saline. Cytologic examination of the filtrate was performed after the filtration process. Results: The incidence of positive cytology during laparoscopic surgery was 32.26% in the preoperative lavage and 22.58% in the postoperative lavage. The incidence of positive cytology during conventional surgery was 41.18% before lavage and 26.47% after lavage. Only one positive cytology was detected in the CO2 filtrate gas. The incidence of positive cytology in the lavage of the instruments during laparoscopic surgery was 6.45%. Conclusion: During gastric laparoscopic surgery, CO2 pneumoperitoneum does not affect tumor cell dissemination and seeding. In this study, laparoscopic techniques used in gastric cancer surgery were not associated with a higher risk for intraperitoneal dissemination of cancer cells than the conventional surgery.

  2. Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

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    Portanova Michel

    2010-08-01

    Full Text Available Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent total gastrectomy, 9 of them had esophagojejunal fistula (5.2%. In three selected patients a trans-anastomotic naso-enteral feeding tube was placed under fluoroscopic vision when the fistula was clinically detected and a complete polymeric enteral formula was used. Results The complete closing of the esophagojejunal fistula was obtained in day 8, 14 and 25 respectively. Conclusion In some selected cases it is possible to make a successful enteral nutrition using a feeding tube distal to the leak area inserted with the help of fluoroscopic vision. The specialized management of a gastric surgery unit and nutritional therapy unit are highlighted.

  3. Endoscopic Retrograde Cholangiopancreatography Using a Dual-Lumen Endogastroscope for Patients with Billroth II Gastrectomy

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    Wei Yao

    2013-01-01

    Full Text Available Objective. To evaluate the safety and efficacy of a dual-lumen forward-viewing endoscope for ERCP in patients with prior Billroth II gastrectomy. Methods. The records of 46 patients treated with ERCP by a dual-lumen forward-viewing endoscope after Billroth II gastrectomy from 2007 to 2012 were reviewed. Results. The success rate of selective cannulation was 82.6% (38/46. Of the 38 cases with successful selective cannulation, endoscopic sphincterotomy was achieved in 23 cases by placing the needle knife through the 2nd lumen, while endoscopic papillary balloon dilatation was conducted in the other 15 cases. Of the 8 failed cases of selective cannulation, 6 had failed afferent loop intubation, and 3 of these 6 patients had Braun’s anastomosis. The safety and efficacy of catheter-assisted endoscopic sphincterotomy were increased by placing the needle knife through the 2nd lumen without altering the conventional endoscopic sphincterotomy procedure. Conclusions. A dual-lumen forward-viewing endoscope can be safely and effectively used to perform ERCP in patients with a Billroth II gastrectomy, except for patients with additional Braun’s anastomosis.

  4. Gastroduodenal ulcer treated by pylorus and pyloric vagus-preser-ving gastrectomy

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    AIM To evaluate the curative effect of pylorus and pyloric vagus-preserving gastrectomy (PPVPG) on peptic ulcer.METHODS Treating 132 cases of GU and DU with PPVPG, and comparative studies made with 24 cases treated with Billroth Ⅰ (BⅠ) and 20 cases with Billroth Ⅱ (BⅡ); advantages and shortcomings evaluated.RESULTS Not a single death after PPVPG. No recurrence of the disorder in the subsequent follow-up for an average of 6.5 years. Curative effect (visik Ⅰ & Ⅱ) 97.7%. Acidity reduction similar to that found in BⅠ and BⅡ, but 97.7% of the BⅠ and all BⅡ cases having more than second degree intestinal fluid reflux, in contrast to 7.1% in PPVPG cases. Dumping syndrome occurred in the BⅠ and BⅡ cases, none in PPVPG cases. With regard to gastric emptying, food digestion, absorption, body weight and life quality, PPVPG proved to be superior to Billroth procedure.CONCLUSION PPVPG has the advantages of conventional Billroth gastrectomy in reducing acid, removing ulcer focus, and at the same time preserves the pylorus and pyloric vagus for maintaining the normal gastric physiological function. Dumping syndrome, intestinal fluid reflux and other complications of conventional gastrectomy may be avoided.

  5. Long-term effect on carcinoma of esophagus of distal subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Yu-Ping Chen; Jie-Sheng Yang; Di-Tian Liu; Yu-Quan Chen; Wei-Ping Yang

    2004-01-01

    AIM: To investigate the surgical treatment and long-term survival for patients with carcinoma of esophagus after distal subtotal gastrectomy.METHODS: Resections of the tumor through left thoracotomy were performed in 85 patients with esophageal carcinoma following distal subtotal gastrectomy. The procedure involved preserving the left short gastric artery and transporting the residual stomach, the spleen and tail of the pancreas into the left thoracic cavity, and using the residual stomach to reconstruct the alimentary tract.RESULTS: The resectable rate was 91.8%, complication rate 10.3%, and no death occurred in the postoperative period. The 1-, 3-, 5-, and 10-year survival rates were 85.7%, 50.7%, 30.6% and 18.8%, respectively.CONCLUSION: Surgical resection is the optimal management method for the patients with esophageal carcinoma after distaJ subtotal gastrectomy. The reconstruction of digestive tract using anastomosis of the esophagus and the residual stomach is not only simple but also can achieve a better curative effect, promoting the digestive function and improving the quality of life.

  6. Effects of vagus nerve preservation and vagotomy on peptide YY and body weight after subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Hyung Hun Kim; Moo In Park; Sang Ho Lee; Hyun Yong Hwang; Sung Eun Kim; Seun Ja Park; Won Moon

    2012-01-01

    AIM:To investigate the relationship between the function of vagus nerve and peptide YY3-36 and ghrelin levels after subtotal gastrectomy,METHODS:We enrolled a total of 16 patients who underwent subtotal gastrectomy due to gastric cancer.All surgeries were performed by a single skilled surgeon.We measured peptide YY3-36,ghrelin,leptin,insulin,growth hormone levels,and body weight immediately before and one month after surgery.RESULTS:Vagus nerve preservation group showed less body weight loss and less increase of peptide YY3-36 compared with vagotomy group (-5.56 ± 2.24 kg vs -7.85 ± 1.57 kg,P =0.037 and 0.06 ± 0.08 ng/mL vs 0.19±0.12 ng/mL,P =0.021,respectively).Moreover,patients with body weight loss of less than 10% exhibited reduced elevation of peptide YY3-36 level,typically less than 20% [6 (66.7%) vs 0 (0.0%),P =0.011,odd ratio =3.333,95% confidence interval (1.293,8.591)].CONCLUSION:Vagus nerve preservation contributes to the maintenance of body weight after gastrectomy,and this phenomenon may be related to the suppressed activity of peptide YY3-36.

  7. Surgical outcomes of 2041 consecutive laparoscopic gastrectomy procedures for gastric cancer: a large-scale case control study.

    Directory of Open Access Journals (Sweden)

    Jian-Xian Lin

    Full Text Available BACKGROUND: Laparoscopic gastrectomy (LG for gastric cancer has increased in popularity due to advances in surgical techniques. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer compared with open gastrectomy (OG. METHODS: The study comprised 3,580 patients who were treated with curative intent either by laparoscopic gastrectomy (2,041 patients or open gastrectomy (1,539 patents between January 2005 and October 2013. The surgical outcomes were compared between the two groups. RESULTS: Laparoscopic gastrectomy was associated with significantly less blood loss, transfused patient number, time to ground activities, and post-operative hospital stay, but with similar operation time, time to first flatus, and time to resumption of diet, compared with the open gastrectomy. No significant difference in the number of lymph nodes dissected was observed between these two groups. The morbidity and mortality rates of the LG group were comparable to those of the OG group (13.6% vs. 14.4%, P = 0.526, and 0.3% vs. 0.2%, P = 0.740. The 3-year disease-free and overall survival rates between the two groups were statistically significant (P<0.05. According to the UICC TNM classification of gastric cancer, the 3-year disease-free and overall survival rates were not statistically different at each stage. CONCLUSIONS: Our single-center study of a large patient series revealed that LG for gastric cancer yields comparable surgical outcomes. This result was also true of local advanced gastric cancer (AGC. A well-designed randomized controlled trial comparing surgical outcomes between LG and OG in a larger number of patients for AGC can be carried out.

  8. Laparoscopic-assisted gastrectomy versus open gastrectomy for T4a gastric cancer in short-term and long-term outcomes.

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:To study thesafety of oncologic short-term and long-term outcomes of laparoscopic-assisted gastrectomy (LAG) performed for T4a stage gastric cancer. Methods: Between January 2009 and December 2014, 86 patients with American Joint Committee on Cancer (AJCC) stage T4a gastric cancer underwent LAG or conventional open gastrectomy (OG). Of these patients, 43 patients underwent LAG and they were compared with patients who underwent OG regarding short-term and long-term outcome. Results:The N stage (P=0.685) did not differ between the LAG and OG groups. Postoperative morbidity occurred in 6 (14.0%) OG and 8 (9.3%) LAG cases and postoperative mortality occurred 2 (4.0%) and 0 (0.0%) cases of OG and LAG, respectively. Recurrence occurred in 6 (14.0%) cases and 4 (9.3%) case in the OG and LAG group, respectively (P=0.077). hTe mean survival time in the OG group was 53.86 m)and in the LAG was 53.97 m with no signiifcant difference (P=0.295).Conclusion:The LAG is a feasible and safe procedure, and has several advantages over conventional OG.

  9. Outcome after gastrectomy in gastric cancer patients with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    Jong Won Kim; Jae-Ho Cheong; Woo Jin Hyung; Seung-Ho Choi; Sung Hoon Noh

    2012-01-01

    AIM: To evaluate the prognosis of type Ⅱ diabetes mellitus (T2DM) after gastrectomy and related factors in gastric cancer patients. METHODS: 403 gastric cancer patients with T2DM were studied, who underwent gastrectomy between May 2003 and September 2009. A review of medical records and telephone interviews was performed in this cross-sectional study. The factors included in the statistical analysis were as follows: gender, age, type of surgery, preoperative body mass index (BMI), current BMI, BMI reduction ratio, preoperative insulin or oral diabetic medicine requirement, follow-up duration, and current state of diabetes. Assessment of diabetes status after surgery was classified into four categories according to the change in hypoglycemic agents after surgery and present status of T2DM: resolution, improvement, same, and worse. RESULTS: The mean follow-up duration was 33.7 mo (± 20.6 mo), preoperative BMI was 24.7 kg/m2 (± 3.0 kg/m2), and BMI reduction ratio was 9.8% (± 8.6%). After surgery, T2DM was cured in 58 patients (15.1%) and was improved in 117 patients (30.4%). According to the type of surgery, the BMI reduction ratio was significantly higher in the total gastrectomy and Roux-en-Y reconstruction group [14.2% ± 9.2% vs 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001] and significantly lower in the subtotal gastrectomy and Billroth Ⅰ reconstruction group [7.6% ± 8.0%, 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001]. The BMI reduction ratio, follow-up duration after surgery, type of surgery, extent of gastrectomy, and performance of duodenal bypass were significantly correlated to the course of T2DM (P < 0.05). The BMI reduction ratio was the most influential factor on T2DM status. In a subgroup analysis of patients with a BMI reduction ratio of 10% or less (n = 206), T2DM was cured in 15 (7.6%) patients and was improved in 57 (28.8%) patients after surgery, and only the duration of surgery was significantly correlated to T2DM status (P = 0

  10. Analysis of risk factors for the interval time, number and pattern of hepatic metastases from gastric cancer after radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Jing-Yu Deng; Han Liang; Dan Sun; Hong-Jie Zhan; Ru-Peng Zhang

    2008-01-01

    AIM: To analyze the risk factors for interval time,number and pattern of hepatic metastases from gastric cancer after radical gastrectomy, and provide evidence for predicting and preventing hepatic metastasis from gastric cancer after radical gastrectomy. METHODS: A retrospective study of 87 patients with hepatic metastasis who underwent radical gastrectomy for gastric cancer from 1996 to 2001. The data was analyzed to evaluate significant risk factors for interval time, number and pattern of hepatic metastases originating from gastric cancer after radical gastrectomy.RESULTS: The size of gastric cancer and lymph node metastases were independently correlated with the interval time of hepatic metastases; the depth of invasion was independently correlated with the number of hepatic metastases; while the depth of invasion and Lauren classification were independently correlated with the pattern of hepatic metastases.CONCLUSION: We evaluated the interval time of hepatic metastases with the size of gastric cancer and lymph node metastases. The depth of invasion could be used to evaluate the number of hepatic metastases, while the depth of invasion and the Lauren classification could be used to evaluate the pattern of hepatic metastases in patients who underwent radical gastrectomy.

  11. A Case of Laparoscopic Resection for Carcinoma of the Gastric Remnant following Proximal Gastrectomy Reconstructed with Jejunal Interposition

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    Kazuhito Yajima

    2016-01-01

    Full Text Available A 72-year-old Japanese man had a history of proximal gastrectomy for early gastric cancer located in the upper third of the stomach in 2007. Our usual treatment strategy for early gastric cancer in the upper third of the stomach in 2007 was open proximal gastrectomy reconstructing by jejunal interposition with a 10 cm single loop. Upper gastrointestinal fiberscopy for annual follow-up revealed a type 0-IIc-shaped tumor with ulcer scar, 4.0 cm in size, located in the gastric remnant near the jejunogastrostomy. A clinical diagnosis of cancer of the gastric remnant, clinical T1b(SMN0M0, Stage IA, following the proximal gastrectomy was made and a laparoscopic approach was selected because of the cancer’s early stage. Remnant total gastrectomy with D1 plus lymphadenectomy was carried out with five ports by a pneumoperitoneal method. Complete resection of the reconstructed jejunum was undergone along with the jejunal mesentery. Reconstruction by the Roux-en-Y method via the antecolic route was selected. Total operative time was 395 min and blood loss was 40 mL. Our patient was the first successful case of resection for carcinoma of the gastric remnant following proximal gastrectomy reconstructed with jejunal interposition in a laparoscopic approach.

  12. A Case of Laparoscopic Resection for Carcinoma of the Gastric Remnant following Proximal Gastrectomy Reconstructed with Jejunal Interposition

    Science.gov (United States)

    Iwasaki, Yoshiaki; Yuu, Ken; Oohinata, Ryouki; Amaki, Misato; Kohira, Yoshinori; Natsume, Souichiro; Ishiyama, Satoshi; Takahashi, Keiichi

    2016-01-01

    A 72-year-old Japanese man had a history of proximal gastrectomy for early gastric cancer located in the upper third of the stomach in 2007. Our usual treatment strategy for early gastric cancer in the upper third of the stomach in 2007 was open proximal gastrectomy reconstructing by jejunal interposition with a 10 cm single loop. Upper gastrointestinal fiberscopy for annual follow-up revealed a type 0-IIc-shaped tumor with ulcer scar, 4.0 cm in size, located in the gastric remnant near the jejunogastrostomy. A clinical diagnosis of cancer of the gastric remnant, clinical T1b(SM)N0M0, Stage IA, following the proximal gastrectomy was made and a laparoscopic approach was selected because of the cancer's early stage. Remnant total gastrectomy with D1 plus lymphadenectomy was carried out with five ports by a pneumoperitoneal method. Complete resection of the reconstructed jejunum was undergone along with the jejunal mesentery. Reconstruction by the Roux-en-Y method via the antecolic route was selected. Total operative time was 395 min and blood loss was 40 mL. Our patient was the first successful case of resection for carcinoma of the gastric remnant following proximal gastrectomy reconstructed with jejunal interposition in a laparoscopic approach. PMID:27034881

  13. [Simultaneous totally laparoscopic total gastrectomy and low anterior resection for synchronous gastric and rectal cancer; a case report].

    Science.gov (United States)

    Hidaka, Gen; Saeki, Hiroshi; Oki, Eiji; Morita, Masaru; Ikeda, Tetsuo; Maehara, Yoshihiko

    2013-08-01

    Simultaneous operations for synchronous cancers are thought to increase in the near future due to recent advancement of laparoscopic surgery. A 75-year-old male patient was admitted to our hospital and diagnosed as synchronous gastric and rectal cancer (gastric cancer: cT2N0M0 StageIB, rectal cancer: cSEN0M0 StagII). The simultaneous totally laparoscopic total gastrectomy and low anterior resection was scheduled. The low anterior resection was first performed with five ports on the lower abdomen, and followed by the total gastrectomy with addition of 3 ports on the upper abdomen. The postoperative course was uneventful. This case suggest that the simultaneous totally laparoscopic total gastrectomy and low anterior resection was useful operation for patients with synchronous gastric and rectal cancers. We herein report the case and discuss based on some literatures.

  14. Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China

    Directory of Open Access Journals (Sweden)

    Lin Jian-Xian

    2013-01-01

    Full Text Available Abstract Background Gastric cancer is a common malignancy worldwide and a common cause of death from cancer. Despite recent advances in multimodality treatment and targeted therapy, complete resection remains the only treatment that can lead to cure. This study was devised to investigate the technical feasibility, safety and oncologic efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer without serosa invasion. Methods A retrospective matched cohort study was performed in south China comparing laparoscopy-assisted gastrectomy and open gastrectomy for advanced gastric cancer without serosa invasion. Eighty-three patients with advanced gastric cancer undergoing laparoscopy-assisted gastrectomy between January 2008 and December 2010 were enrolled. These patients were compared with 83 patients with advanced gastric cancer undergoing open gastrectomy during the same period. Results There was no significant difference in clinicopathologic characteristics between the two groups. Regarding perioperative characteristics, the operation time and time to ground activities did not differ between the two groups, whereas the blood loss, transfused patient number, time to first flatus, time to resumption of diet, and postoperative hospital stay were significantly less in laparoscopy-assisted gastrectomy than in open gastrectomy (P Conclusion Laparoscopy-assisted gastrectomy with D2 lymphadenectomy is a safe and feasible procedure for advanced gastric cancer without serosa invasion. To be accepted as a choice treatment for advanced gastric cancer, well-designed randomized controlled trials comparing short-term and long-term outcomes between laparoscopy-assisted gastrectomy and open gastrectomy in a larger number of patients are necessary.

  15. External post-tensioning of cfrp tendons using integrated sleeve-wedge anchorage

    DEFF Research Database (Denmark)

    Schmidt, Jacob Wittrup; Bennitz, Anders; Goltermann, Per

    2012-01-01

    Strengthening of structures using external post-tension CFRP systems have proven to be anefficient method as such system increases the structural capacity and reduces cracks and deflection. Sufficient anchorage is of significant importance since the anchorage provides the connection between...... the post-tensioning system and the remaining structure. A special designed integrated sleeve-wedge anchorage has therefore been designed to improve the reliability of the mounting procedure, reduce the possible modes of failure and thus provide desired anchorage. The present research shows that adequate...

  16. Repair boundary for parent tube indications within the upper joint zone of hybrid expansion joint (HEJ) sleeved tubes

    Energy Technology Data Exchange (ETDEWEB)

    Cullen, W.K.; Keating, R.F. [Westinghouse Electric, Pittsburgh, PA (United States)

    1997-02-01

    In the Spring and Fall of 1994, and the Spring of 1995, crack-like indications were found in the upper hybrid expansion joint (HEJ) region of Steam Generator (S/G) tubes which had been sleeved using Westinghouse HEJ sleeves. As a result of these findings, analytic and test evaluations were performed to assess the effect of the degradation on the structural, and leakage, integrity of the sleeve/tube joint relative to the requirements of the United States Nuclear Regulatory Commission`s (NRC) draft Regulatory Guide (RG) 1.121. The results of these evaluations demonstrated that tubes with implied or known crack-like circumferential parent tube indications (PTIs) located 1.1 inches or farther below the bottom of the hardroll upper transition, have sufficient, and significant, integrity relative to the requirements of RG 1.121. Thus, the purpose of this report is to provide background information related to the justification of the modified tube repair boundary.

  17. Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies

    Directory of Open Access Journals (Sweden)

    Mikito Inokuchi

    2016-01-01

    Full Text Available Background. Some meta-analyses of case-controlled studies (CCSs have shown that laparoscopic or laparoscopy-assisted total gastrectomy (LTG had some short-term advantages over open total gastrectomy (OTG. However, postoperative complications differed somewhat among the meta-analyses, and some CCSs included in the meta-analyses had mismatched factors between LTG and OTG. Methods. CCSs comparing postoperative complications between LTG and OTG were identified in PubMed and Embase. Studies matched for patients’ status, tumor stage, and the extents of lymph-node dissection were included. Outcomes of interest, such as anastomotic, other intra-abdominal, wound, and pulmonary complications, were evaluated in a meta-analysis performed using Review Manager version 5.3 software. Result. This meta-analysis included a total of 2,560 patients (LTG, 1,073 patients; OTG, 1,487 patients from 15 CCSs. Wound complications were significantly less frequent in LTG than in OTG (n = 2,430; odds ratio [OR] 0.30, 95% confidence interval [CI] 0.29–0.85, P=0.01, I2 = 0%, and OR 0.46, 95% CI 0.17–0.52, P<0.0001, I2 = 0%. However, the incidence of anastomotic complications was slightly but not significantly higher in LTG than in OTG (n = 2,560; OR 1.44, 95% CI 0.96–2.16, P=0.08, I2 = 0%. Conclusion. LTG was associated with a lower incidence of wound-related postoperative complications than was OTG in this meta-analysis of CCSs; however, some concern remains about anastomotic problems associated with LTG.

  18. XbaⅠpolymorphisms of apolipoprotein B gene:Another risk factor of gallstone formation after radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To prospectively investigate the association between the XbaⅠpolymorphisms of apolipoprotein B (APOB)gene and gallstone formation following gastrectomy.METHODS:The study was conducted between January 2005 and December 2006.A total of 186 gastric cancer patients who had undergone radical gastrectomy were grouped according to XbaⅠpolymorphisms of APOB gene(X+X-group,n=24 and X-X-group,n =162)and compared.The XbaⅠpolymorphisms of APOB gene were detected by polymerase chain reaction-restriction fragment len...

  19. Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Nobuaki Fujikuni; Kazuaki Tanabe; Noriaki Tokumoto; Takahisa Suzuki; Minoru Hattori; Toshihiro Misumi; Hideki Ohdan

    2016-01-01

    AIM: To assess the safety of enhanced recovery after surgery(ERAS) program in gastrectomy and influences on nutrition state and insulin-resistance. METHODS: Our ERAS program involved shortening the fasting periods and preoperative carbohydrate loading. Eighty gastrectomy patients were randomly assigned to either the conventional group(CG) or ERAS group(EG). We assessed the clinical characteristics and postoperative outcomes prospectively. The primary endpoint was noninferiority in timely discharge from the hospital within 12 d. Secondary endpoints were the incidence of aspiration at anesthesia induction, incidence of postoperative complications, health related quality of life(HRQOL) using the SF8 Health Survey questionnaire, nutrition state [e.g., albumin, transthyretin(TTR), retinal-binding protein(RBP), and transferrin(Tf)], the homeostasis model assessment-insulin resistance(HOMA-R) index, postoperative urine volume,postoperative weight change, and postoperative oral intake.RESULTS: The ERAS program was noninferior to the conventional program in achieving discharge from the hospital within 12 d(95.0% vs 92.5% respectively; 95%CI:-10.0%-16.0%). There was no significant difference in postoperative morbidity between the two groups. Adverse events such as vomiting and aspiration associated with the induction of general anesthesia were not observed. There were no significant differences with respect to postoperative urine volume, weight change, and oral intake between the two groups. EG patients with preoperative HOMA-R scores above 2.5 experienced significant attenuation of their HOMA-R scores on postoperative day 1 compared to CG patients(P = 0.014). There were no significant differences with respect to rapid turnover proteins(TTR, RBP and Tf) or HRQOL scores using the SF8 method.CONCLUSION: Applying the ERAS program to patients who undergo gastrectomy is safe, and improves insulin resistance with no deterioration in QOL.

  20. Gastrectomy for gastric carcinoma with situs inversus totalis: case report and literature review

    Science.gov (United States)

    Zhu, H; Yang, K; Hu, JK

    2015-01-01

    Background: Situs inversus totalis (SIT), a rare congenital anomaly, is characterized by a complete mirror image transposition of the thoracic and abdominal viscera. We report the case of a 66-year-old woman with SIT who was diagnosed with gastric antral carcinoma. Curative distal gastrectomy with Billroth-I anastomosis was performed. Description of the case: A 66-year-old woman visited our outpatient department complaining of abdominal pain in the left upper quadrant for about one year. Physical examination revealed that the apex beat was in the right fifth intercostal space, just at the midclavicular line while a soft systolic murmur was audible at the upper right sternal border. The abdominal examination was unremarkable. The preoperative diagnosis was confirmed by gastroscopy and biopsy. Preoperative echocardiogram revealed the presence of dextrocardia and atrial septal defect. Preoperative contrasted computed tomography showed a complete right-left reversal of the thoracic and abdominal organs and thickened wall of gastric antrum without distant metastasis. Laparotomy through a midline incision confirmed the complete mirror-image transposition of the abdominal visceral organs and a 4-cm tumor with serosal involvement at the gastric antrum. Curative distal gastrectomy with D2 lymphadenectomy and Billroth-I anastomosis was performed. The patient had a rapid recovery and was discharged without any complications. The final staging of this case was pT4aN1M0, stage IIIa and she received chemotherapy with the SOX regimen for three cycles. Fifteen months after the operation, the patient is alive without any signs of recurrence. Conclusions: The incidence of gastric cancer with SIT is very rare. Appropriate diagnostic modalities are very helpful for the diagnosis and preoperative planning. Gastrectomy with D2 lymphadenectomy in patients with SIT can be performed successfully with sufficient preoperative evaluation, comprehensive knowledge of anatomy, and meticulous

  1. Rabeprazole is effective for bile reflux oesophagitis after total gastrectomy in a rat model

    Institute of Scientific and Technical Information of China (English)

    Naoki; Hashimoto

    2015-01-01

    AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.

  2. Effects of sleeve blockages on axial velocity and intensity of turbulence in an unheated 7 x 7 rod bundle. [PWR

    Energy Technology Data Exchange (ETDEWEB)

    Creer, J.M.; Rowe, D.S.; Bates, J.M.; Sutey, A.M.

    1976-01-01

    An experimental study is described which was performed to investigate the turbulent flow phenomena near postulated sleeve blockages in a model nuclear fuel rod bundle. The sleeve blockages were characteristic of fuel clad ''swelling'' or ''ballooning'' which could occur during loss-of-coolant accidents (LOCA) in pressurized water reactors. The study was conducted to provide information relative to the flow phenomena near postulated blockages to support detailed safety analyses of LOCAs. The results of the study are especially useful for verification of the hydraulic treatment of reactor core computer programs such as COBRA.

  3. Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report

    Science.gov (United States)

    Furukawa, Kenei; Tsutsumi, Jun; Takayama, Sumio; Mashiko, Hiroshi; Shiba, Hiroaki; Yanaga, Katsuhiko

    2015-01-01

    A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition. PMID:25785319

  4. Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report.

    Science.gov (United States)

    Furukawa, Kenei; Tsutsumi, Jun; Takayama, Sumio; Mashiko, Hiroshi; Shiba, Hiroaki; Yanaga, Katsuhiko

    2015-03-01

    A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition.

  5. Mechanical behavior of pre tensioned metallic sleeves for pipeline repair; Comportamento mecanico de luvas metalicas pre tensionadas para reparo de dutos terrestres

    Energy Technology Data Exchange (ETDEWEB)

    Meniconi, Luiz C.M.; Paes, Marcelo T. Piza [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil). Centro de Pesquisas; Frainer, Vitor [Rio Grande do Sul Univ., Porto Alegre, RS (Brazil). Dept. de Metalurgia. Lab. de Metalurgia Fisica (LAMEF); Souza Filho, Byron G. de [PETROBRAS Transportes S.A. (TRANSPETRO), Rio de Janeiro, RJ (Brazil); Patricio, Wagner [Foxoil do Brasil Ltda., Macae, RJ (Brazil)

    2005-07-01

    Two different methods for pre-tensioning of metallic sleeves for pipeline repair were appraised: mechanic, by means of hydraulic jacks, and thermal, trough the use of oxyacetylene torches. Hydraulic jacks promote an 'in situ' forming of the sleeves, once they impose loads rather than displacements. There is no need of a perfect match between the external diameter of the pipe and the internal diameter of the sleeve. The thermal method, on the other hand, needs a tight fit between the sleeve and the pipe to assure that thermal expansion will turn into elastic deformation. Test specimens were built with four different defect types: crack, dent, gouged dent and thickness loss due to corrosion. The use of pre-tensioned sleeves led to failure pressures 39% above the hydro test pressure, at least. All the specimen failures occurred outside the reinforced area. (author)

  6. Numerical Analysis and Experimental Study of Hard Roofs in Fully Mechanized Mining Faces under Sleeve Fracturing

    Directory of Open Access Journals (Sweden)

    Zhitao Zheng

    2015-11-01

    Full Text Available Sudden falls of large-area hard roofs in a mined area release a large amount of elastic energy, generate dynamic loads, and cause disasters such as impact ground pressure and gas outbursts. To address these problems, in this study, the sleeve fracturing method (SFM was applied to weaken a hard roof. The numerical simulation software FLAC3D was used to develop three models based on an analysis of the SFM working mechanism. These models were applied to an analysis of the fracturing effects of various factors such as the borehole diameter, hole spacing, and sleeve pressure. Finally, the results of a simulation were validated using experiments with similar models. Our research indicated the following: (1 The crack propagation directions in the models were affected by the maximum principal stress and hole spacing. When the borehole diameter was fixed, the fracturing pressure increased with increasing hole spacing. In contrast, when the fracturing pressure was fixed, the fracturing range increased with increasing borehole diameter; (2 The most ideal fracturing effect was found at a fracturing pressure of 17.6 MPa in the model with a borehole diameter of 40 mm and hole spacing of 400 mm. The results showed that it is possible to regulate the falls of hard roofs using the SFM. This research may provide a theoretical basis for controlling hard roofs in mining.

  7. Gastric microbiota and predicted gene functions are altered after subtotal gastrectomy in patients with gastric cancer.

    Science.gov (United States)

    Tseng, Ching-Hung; Lin, Jaw-Town; Ho, Hsiu J; Lai, Zi-Lun; Wang, Chang-Bi; Tang, Sen-Lin; Wu, Chun-Ying

    2016-02-10

    Subtotal gastrectomy (i.e., partial removal of the stomach), a surgical treatment for early-stage distal gastric cancer, is usually accompanied by highly selective vagotomy and Billroth II reconstruction, leading to dramatic changes in the gastric environment. Based on accumulating evidence of a strong link between human gut microbiota and host health, a 2-year follow-up study was conducted to characterize the effects of subtotal gastrectomy. Gastric microbiota and predicted gene functions inferred from 16S rRNA gene sequencing were analyzed before and after surgery. The results demonstrated that gastric microbiota is significantly more diverse after surgery. Ralstonia and Helicobacter were the top two genera of discriminant abundance in the cancerous stomach before surgery, while Streptococcus and Prevotella were the two most abundant genera after tumor excision. Furthermore, N-nitrosation genes were prevalent before surgery, whereas bile salt hydrolase, NO and N2O reductase were prevalent afterward. To our knowledge, this is the first report to document changes in gastric microbiota before and after surgical treatment of stomach cancer.

  8. Effect of Acupuncture on Postoperative Ileus after Distal Gastrectomy for Gastric Cancer

    Science.gov (United States)

    Jung, Se Yun; Chae, Hyun Dong; Kang, Ung Rae; Kwak, Min Ah

    2017-01-01

    Purpose Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. Materials and Methods Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. Results The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (Pacupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. Conclusions In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy. PMID:28337359

  9. Safe major abdominal operations:Hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients

    Institute of Scientific and Technical Information of China (English)

    Yu-Lian Wu; Jun-Xiu Yu; Bin Xu

    2004-01-01

    AIM: To evaluate the impact of advanced age on outcome after hepatectomy, gastrectomy and pancreatoduodenectomy.METHODS: Two hundreds and eleven patients undergone hepatectomy, gastrectomy and pancreatoduodenectomy from January 1998 to September 2002 were analyzed retrospectively. Clinicopathologic features and operative outcome of 83 patients aged 65 years or more were compared with that in 128 younger patients aged less than 65 years.RESULTS: The nutritional state, such as pre-operation level of serum albumin and hemoglobin in the older patients was poorer than that in the younger patients. The older patients had higher comorbidities than the younger patients (48.2%vs 15.6%). No significant difference was observed in perioperative mortality, and complication rate between the older and younger patients (2.4% vs 1.6% and 22.9% vs20.3%, respectively). Multivariate analysis demonstrated that pancreatoduodenectomy, hepatectomy with resection of more than 2 segments and comorbidities were independent predictors of postoperative complication, whereas age was not (P=0.3172).CONCLUSION: It is safe for patients aged 65 years or more to undergo hepatic, pancreatic and gastric resection if great care is taken during perioperative period.

  10. High prevalence of osteoporosis in patients with gastric adenocarcinoma following gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the prevalence and predictive factors of osteoporosis in patients with gastric adenocarcinoma after gastrectomy.METHODS: The study included 133 patients diagnosed with gastric adenocarcinoma but who did not undergo prior diagnostic work-up for osteoporosis. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) and vertebral deformity was assessed by plain X-rays. We evaluated the effects of age, sex, body mass index (BMI), anemia, back pain,vertebral deformity, tumor staging, reconstruction type,and past medical history to determine predictive factors of osteoporosis in these patients.RESULTS: The prevalence of osteoporosis in the lumbar spine was 38.3% (male, 28.9%; female, 54.0%), and 15.0% in the femoral neck (male, 10.8%; female,22.0%). The vertebral deformity rate was 46.6% (male,43.4%; female, 52.0%). Age, BMI and hemoglobin correlated with BMD (P < 0.01). In males, anemia and age > 64 years were independent predictive factors of osteoporosis in multivariate analysis. In females, back pain was an independent factor for osteoporosis.CONCLUSION: The results of this study revealed that prevalence of osteoporosis and vertebral bone deformity rate were high in gastric cancer patients, regardless of post-gastrectomy duration and operation type. Early diagnosis and a proper management plan must be established in these patients.

  11. Evaluation of gastrectomy in patients with delayed gastric emptying after antireflux surgery or large hiatal hernia repair

    NARCIS (Netherlands)

    Gerritsen, A.; Furnee, E.J.B.; Gooszen, H.G.; Wondergem, M.; Hazebroek, E.J.

    2013-01-01

    BACKGROUND: Revision antireflux surgery and large hiatal hernia repair require extensive dissection at the gastroesophageal junction. This may lead to troublesome symptoms due to delayed gastric emptying, eventually requiring gastrectomy. The aim of this study was to evaluate the outcome of gastrect

  12. Behandling med duodenal-jejunal bypass-sleeve ved svær overvægt

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  13. Biological conduit small gap sleeve bridging method for peripheral nerve injury: regeneration law of nerve fibers in the conduit

    Directory of Open Access Journals (Sweden)

    Pei-xun Zhang

    2015-01-01

    Full Text Available The clinical effects of 2-mm small gap sleeve bridging of the biological conduit to repair peripheral nerve injury are better than in the traditional epineurium suture, so it is possible to replace the epineurium suture in the treatment of peripheral nerve injury. This study sought to identify the regeneration law of nerve fibers in the biological conduit. A nerve regeneration chamber was constructed in models of sciatic nerve injury using 2-mm small gap sleeve bridging of a biodegradable biological conduit. The results showed that the biological conduit had good histocompatibility. Tissue and cell apoptosis in the conduit apparently lessened, and regenerating nerve fibers were common. The degeneration regeneration law of Schwann cells and axons in the conduit was quite different from that in traditional epineurium suture. During the prime period for nerve fiber regeneration (2-8 weeks, the number of Schwann cells and nerve fibers was higher in both proximal and distal ends, and the effects of the small gap sleeve bridging method were better than those of the traditional epineurium suture. The above results provide an objective and reliable theoretical basis for the clinical application of the biological conduit small gap sleeve bridging method to repair peripheral nerve injury.

  14. Biological conduit small gap sleeve bridging method for peripheral nerve injury:regeneration law of nerve ifbers in the conduit

    Institute of Scientific and Technical Information of China (English)

    Pei-xun Zhang; Li-ya A; Yu-hui Kou; Xiao-feng Yin; Feng Xue#; Na Han; Tian-bing Wang; Bao-guo Jiang

    2015-01-01

    The clinical effects of 2-mm small gap sleeve bridging of the biological conduit to repair periph-eral nerve injury are better than in the traditional epineurium suture, so it is possible to replace the epineurium suture in the treatment of peripheral nerve injury. This study sought to identify the regeneration law of nerve fibers in the biological conduit. A nerve regeneration chamber was constructed in models of sciatic nerve injury using 2-mm small gap sleeve bridging of a biodegradable biological conduit. The results showed that the biological conduit had good his-tocompatibility. Tissue and cell apoptosis in the conduit apparently lessened, and regenerating nerve ifbers were common. The degeneration regeneration law of Schwann cells and axons in the conduit was quite different from that in traditional epineurium suture. During the prime period for nerve fiber regeneration (2–8 weeks), the number of Schwann cells and nerve fibers was higher in both proximal and distal ends, and the effects of the small gap sleeve bridging method were better than those of the traditional epineurium suture. The above results provide an objec-tive and reliable theoretical basis for the clinical application of the biological conduit small gap sleeve bridging method to repair peripheral nerve injury.

  15. Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Qi, Jin; Zhang, Peng; Wang, Yanan; Chen, Hao; Li, Yumin

    2016-01-01

    Background/Aims Total gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer. Methodology A search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis. Results Ten retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90–2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31–51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26–1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34–6.31, p0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0.85–0.97,p = 0.006). Conclusion Based on current retrospective evidences, we found that in spite of similar postoperative mortality, TG for distal gastric cancer provided a high risk of five-year Overall Survival rate. DG procedure can be a recommendation for distal gastric cancer, whereas due to lack of high quality RCTs in multicenter and the relatively small sample size of long-term outcomes, further comparative studies are still

  16. Late results of mucosal proctectomy and colo-anal sleeve anastomosis for chronic irradiation rectal injury

    Energy Technology Data Exchange (ETDEWEB)

    Browning, G.G.P.; Varma, J.S.; Smith, A.N.; Small, W.P.; Duncan, W.

    1987-01-01

    Ten patients with severe chronic irradiation injury to the rectum were treated by mucosal proctectomy and colo-anal sleeve anastomosis. The indications were: recurrent rectal bleeding (five), stricture (three), fistula (one) and intractable pain (one). Overall follow-up has ranged from 8 to 77 months (mean 40 months). In the present survivors (n=7) the follow-up ranges from 18 to 77 months (mean 52 months). Six patients have been followed up for more than 3 years and four for more than 5 years. There was no operative mortality. Three anastomotic strictures occurred but the protecting stoma could be closed in all but one patient. Continence was acceptable although urgency and frequency of defaecation were troublesome symptoms. The operation is recommended for life-threatening, haemorrhagic chronic irradiation injury to the rectum.

  17. 1例Prader-Willi综合征行腹腔镜袖状胃减容术患儿的护理%Nursing care of a child with Prader-Willi Syndrome managed with laparoscopic sleeve gastrectomy

    Institute of Scientific and Technical Information of China (English)

    高蔚; 顾莺; 罗飞宏; 施琼

    2012-01-01

    总结1例Prader-Willi综合征患儿行腹腔镜袖状胃减容术的围术期护理.护理要点包括充分的各项术前准备,心理护理和体质量控制;术后严密的病情观察,做好皮肤及切口护理,尤其是加强饮食控制,做好出院宣教及定期随访.患儿恢复顺利,术后24 d康复出院.

  18. Band Together!

    Science.gov (United States)

    Olson, Cathy Applefeld

    2011-01-01

    After nearly a decade as band director at St. James High School in St. James, Missouri, Derek Limback knows that the key to building a successful program is putting the program itself above everything else. Limback strives to augment not only his students' musical prowess, but also their leadership skills. Key to his philosophy is instilling a…

  19. Quality of life of patients with carcinoma of stomach after radical gastrectomy%胃癌根治术后患者生活质量评价

    Institute of Scientific and Technical Information of China (English)

    李健; 马骏; 张晓云; 周璐

    2003-01-01

    @@ INTRODUCTION The radical gastrectomy gives a significant prolongation of survival for patients with gastric cancer.But the operation can cause weigh loss,malabsorption,disturbed eating habits, and psychological disturbances.In this study,food tolerance,body-weigh and performance status were determined in patients after radical gastrectomy for carcinoma.The purpose of the study is to evaluate the extent of gastric resection to assess their impact on quality of life(QOL).

  20. Traumatic Neuroma around the Celiac Trunk after Gastrectomy Mimicking a Nodal Metastasis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jung Hyeok; Ryu, Seung Wan; Kang, Yu Na [Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2007-06-15

    Traumatic neuroma is a well-known disorder that occurs after trauma or surgery involving the peripheral nerve and develops from a nonneoplastic proliferation of the proximal end of a severed, partially transected, or injured nerve. However, in the abdomen, traumatic neuromas have been sporadically reported to occur in the bile duct. We present here a case of traumatic neuroma around the celiac trunk after gastrectomy that mimicks a nodal metastasis. In conclusion, the imaging finding of traumatic neuroma around the celiac trunk was a homogeneous hypovascular mass without narrowing or irregularity of encased arteries and without increased uptake on PET-CT. Although from a clinical standpoint, establishing an accurate preoperative diagnosis is difficult to perform, the presence of a traumatic neuroma should be included in the differential diagnosis of a mass around the celiac trunk in a patient that has undergone celiac nodal dissection.

  1. [A case of partial hepatectomy and gastrectomy for hepatocellular carcinoma with direct invasion to the stomach].

    Science.gov (United States)

    Yoshida, Yuta; Murakami, Masahiro; Shimizu, Junzo; Kawada, Masahiro; Yasuyama, Akinobu; Yoshikawa, Yukihiro; Watase, Chikashi; Nishigaki, Takahiko; Kim, Ho Min; Hitora, Toshiki; Oda, Naofumi; Hirota, Masaki; Yoshikawa, Masato; Morishima, Hirotaka; Ikenaga, Masakazu; Mikata, Shoki; Matsunami, Nobuteru; Hasegawa, Junichi

    2014-11-01

    An 81-year-old man treated with chronic hepatitis C virus (HCV)-related hepatitis and hepatocellular carcinoma (HCC) was diagnosed in 2010 with HCC recurrence (subclass S2) on computed tomography (CT). He refused surgery and was followed up without treatment. In 2012, he was admitted to our hospital because of hematemesis. Gastrointestinal endoscopy revealed a large tumor in the upper gastric corpus, and pathological examination of the tumor revealed HCC; hence, we diagnosed the patient with direct HCC invasion to the stomach. Although active bleeding from the tumor was controlled, he experienced repeated episodes of hematemesis, and the tumor increased in size. Therefore, partial hepatectomy and gastrectomy were performed. It was confirmed that the tumor invaded the stomach wall. Although surgery was effective for gastrointestinal bleeding caused by HCC invasion, the patient died 12 months after surgery because of multiple liver metastases and exacerbated liver failure.

  2. [A rare case of digestive tract hemorrhage of extraluminal origin after total gastrectomy].

    Science.gov (United States)

    Caprino, Paola; Alfieri, Sergio; Rotondi, Fabio; Di Miceli, Dario; Sofo, Luigi; Pacelli, Fabio; Battista Doglietto, Giovanni

    2003-01-01

    The authors report on a case of digestive bleeding (melaena and enterorrhagia) in a patient undergoing total gastrectomy for gastric cancer and later splenectomy for subcapsular haematoma in a different hospital. The source of bleeding was not intraluminal; the bleeding arose from double erosion of the gastroduodenal artery in the tract above the anterior surface of the pancreas, close to the dehiscent duodenal stump. The blood flowed mainly into the enteric district through the open stump thus causing the clinical signs described. The diagnosis was made during an emergency surgical operation for haemorrhagic shock. The patient underwent haemostasis with two stitches on the gastroduodenal artery, external drainage of the duodenum with a Petzer tube, laparostomy of the infected area and ileostomy. After three months he had completely recovered.

  3. Safety and efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer in the elderly.

    Science.gov (United States)

    Qiu, Jiang-Feng; Yang, Bing; Fang, Lei; Li, Yi-Ping; Shi, Yi-Jiu; Yu, Xiu-Chong; Zhang, Mou-Cheng

    2014-01-01

    To evaluate safety and efficacy of laparoscopy-assisted radical gastrectomy (LARG) for advanced gastric cancer patients aged 70 years or older. Clinical data were retrospectively collected from patients with IIA-IIIC gastric cancer who underwent LARG (n = 30) and open radical gastrectomy (ORG, n = 34) in Department of Gastrointestinal Surgery in the Ningbo First Hospital from January 2012 to December 2013. The mean operative time was longer in the LARG group than in the ORG group but there was no statistical difference between the two groups. The intraoperative blood loss (120 ± 52.7 ml vs 227.3 ± 146.9 ml), incidence of postoperative complication (23.0% vs 47%) were lower in the LARG group than those in the ORG group. In addition, the time to first flatus (2.9 ± 0.8 d vs 4.6 ± 1.2 d), time to first ambulation (1.2 ± 0.4 vs 4.1 ± 1.0 d), time of nasogastric intubation (2.5 ± 1.0 d vs 3.5 ± 1.4 d), and postoperative hospital stay (13.0 ± 4.2 d vs 16.9 ± 4.1 d) were significantly shorter in the LARG group than in the ORG group, respectively. No statistical difference in the number of harvested lymph nodes was noted between the two groups (30.2 ± 12.0 vs 28.1 ± 11.8, P > 0.05). LARG is safer, more effective and less invasive for the elderly patients with advanced gastric cancer.

  4. Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Shuhei Komatsu; Yoshiaki Kuriu; Masayoshi Nakanishi; Hitoshi Fujiwara; Toshiya Ochiai; Yukihito Kokuba; Eigo Otsuji; Daisuke Ichikawa; , Kazuma Okamoto; Daito Ikoma; Masahiro Tsujiura; Yukihisa Nishimura; Yasutoshi Murayama; Atsushi Shiozaki; Hisashi Ikoma

    2012-01-01

    AIM:To re-evaluate the recent clinicopathological features of remnant gastric cancer (RGC) and to develop desirable surveillance programs.METHOIDS:Between 1997 and 2008,1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery,Kyoto Prefectural University of Medicine,Japan.Of these,33 patients underwent gastrectomy with lymphadenectomy for RGC.Regarding the initial gastric disease,there were 19 patients with benign disease and 14 patients with gastric cancer.The hospital records of these patients were reviewed retrospectively.RESULTS:Concerning the initial gastric disease,the RGC group following gastric cancer had a shorter interval [P < 0.05; gastric cancer vs benign disease:12 (2-22) vs 30 (4-51) years] and were more frequently reconstructed by Billroth- I procedure than those following benign lesions (P < 0.001).Regarding reconstruction,RGC following Billroth-Ⅱ reconstruction showed a longer interval between surgical procedures [P < 0.001; Billroth- 11 vs Billroth- Ⅰ:32 (5-51) vs 12 (2-36) years] and tumors were more frequently associated with benign disease (P < 0.001) than those following Billroth- I reconstruction.In tumor location of RGC,after Billroth- I reconstruction,RGC occurred more frequently near the suture line and remnant gastric wall.After Billroth- Ⅱ reconstruction,RGC occurred more frequently at the anastomotic site.The duration of followup was significantly associated with the stage of RGC (P < 0.05).Patients diagnosed with early stage RGC such as stage I -Ⅱ tended to have been followed up almost every second year.CONCLUSION:Meticulous follow-up examination and early detection of RGC might lead to a better prognosis.Based on the initial gastric disease and the procedure of reconstruction,an appropriate follow-up interval and programs might enable early detection of RGC.

  5. Roux-en-Y reconstruction does not require gastric decompression after radical distal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Cheng-Jueng Chen; Tsang-Pai Liu; Jyh-Cherng Yu; Sheng-Der Hsua; Tsai-Yuan Hsieh; Heng-Cheng Chu; Chung-Bao Hsieh; Teng-Wei Chen; De-Chuan Chan

    2012-01-01

    AIM: To determine whether routine nasogastric (NG) decompression benefitted patients undergoing radical gastric surgery.METHODS: Between January 1998 and December 2008, 519 patients who underwent distal gastrectomy for gastric cancer were retrospectively divided into 2 time-period cohorts; those treated with Billroth Ⅱ (BⅡ) reconstruction in the first 6 years and those with Roux-en-Y (RY) reconstruction in the last 5 years. In the latter group, the patients were further divided into 2 subgroups; with and without nasogastric decompression.RESULTS: Postoperatively, there were no significant differences in the number of anastomotic leaks between the 3 groups. In the tubeless RY group, time to semi-liquid diet was significantly shorter than in the other 2 groups (4.4 d ± 1.4 d vs 7.2 d ± 1.3 d and 5.9 d ± 1.2 d, P = 0.005). The length of postoperative stay was significantly increased in patients with BⅡ reconstruction compared with patients with RY reconstruction with/without NG decompression (15.4 d ± 4.3 d in BⅡgroup vs 12.6 d ± 3.1 d in decompressed RY and 11.4 d ± 3.4 d in the tubeless RY group, P = 0.035). The postoperative pneumonia rate was lowest in the tubeless group and highest in the BⅡ group (1.4% vs 4.6%, P = 0.01). Severe sore throat was noted in 59 (20.7%) members of the BⅡ group, 18 (17.4%) members of the decompressed RY group and 6 (4.2%) members of the tubeless RY group. Fewer patients in the tubeless group complained of severe sore throat (P = 0.001).CONCLUSION: This study provides support for abandoning routine NG decompression in patients undergoing subtotal gastrectomy with Roux-en-Y gastrojejunostomy.

  6. CT-guided 125I Radioactive Seed Implantation on Regional Lymph Node Metastasis after Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Shi Liangrong; Wu Jun; Jiang Jingting; Wu Changping

    2013-01-01

    Objective:To evaluate the safety and short-term effect of CT-guided 125I radioactive seed implantation on regional lymph node metastasis after gastrectomy. Methods:Twenty-three patients with regional lymph node metastasis after gastrectomy received CT-guided 125I radioactive seed implantation from June, 2007 to July, 2011 in our hospital. The overall activity and amount of radioactive seeds were calculated by simulating source distribution of radioactive seed implantation plan system before operation. 125I seeds were implanted under the guidance of CT. Effective rate was evaluated according to RECIST criterion, 1, 2 and 3 years of survival rates were calculated by life table method, the effect of relative factors on survival was tested by univariate COX model, and the survival differences between subgroups were compared to draw survival curve by log-rank method. Additionally, systemic therapies were given to 20 patients based on lfuorouracil drugs. Results:No severe complications was observed in all study subjects with 14 complete remission (60.9%), 5 particle remission (21.7%) and 4 progressive diseases (17.4%), while 1, 2 and 3 years of survival rates as well as median survival time being (87±7)%,(47±11)%, (13±9)% and (22.1±5.1) months, respectively. Univariate COX analysis showed that the maximum diameter of tumor could badly inlfuence the prognosis (χ2=9.752, P=0.002), and the subgroups analysis relieved the signiifcant difference (χ2=5.828, P=0.016, log-rank test) with 3 cm being the cut-off value. Conclusion:CT-guided 125I radioactive seed implantation has high local control rate with small trauma and slight complications.

  7. CT-guided 125I Radioactive Seed Implantation on Regional Lymph Node Metastasis after Gastrectomy

    Directory of Open Access Journals (Sweden)

    Liangrong Shi

    2013-09-01

    Full Text Available Objective: To evaluate the safety and short-term effect of CT-guided 125I radioactive seed implantation on regional lymph node metastasis after gastrectomy. Methods: Twenty-three patients with regional lymph node metastasis after gastrectomy received CT-guided 125I radioactive seed implantation from June, 2007 to July, 2011 in our hospital. The overall activity and amount of radioactive seeds were calculated by simulating source distribution of radioactive seed implantation plan system before operation. 125I seeds were implanted under the guidance of CT. Effective rate was evaluated according to RECIST criterion, 1, 2 and 3 years of survival rates were calculated by life table method, the effect of relative factors on survival was tested by univariate COX model, and the survival differences between subgroups were compared to draw survival curve by log-rank method. Additionally, systemic therapies were given to 20 patients based on fluorouracil drugs. Results: No severe complications was observed in all study subjects with 14 complete remission (60.9 % , 5 particle remission (21.7 % and 4 progressive diseases (17.4 % , while 1, 2 and 3 years of survival rates as well as median survival time being (87±7 %,(47±11 % , (13±9 % and (22.1±5.1 months, respectively. Univariate COX analysis showed that the maximum diameter of tumor could badly influence the prognosis (χ2 = 9.752, P = 0.002, and the subgroups analysis relieved the significant difference (χ2 = 5.828, P = 0.016, log-rank test with 3 cm being the cut-off value. Conclusion: CT-guided 125I radioactive seed implantation has high local control rate with small trauma and slight complications.

  8. Late onset of chylous ascites following distal gastrectomy with D1(+ dissection for gastric cancer: A case report

    Directory of Open Access Journals (Sweden)

    Hüseyin Çiyiltepe

    2015-12-01

    Full Text Available Chyloperitoneum is the accumulation of lymphatic fluid in the peritoneal cavity. Chylous ascites can occur if it is not recognized during surgery. The incidence of chylous ascites after oncological surgery was approximately 7.4% however, the incidence of lymphorrhea after radical gastrectomy for gastric cancer is so low. Extensive lymph node dissection leads to a higher incidence of lymphorrhea. There have been few cases associated with D1 dissection In most patients conservative treatment is recommended that includes paracentesis, total parenteral nutrition (TPN, a medium chain triglyceride (MCT based diet, and somatostatin. Surgery is the last choice only when conservative treatment fails. In this case we aimed to present a late onset of chylous ascites after subtotal gastrectomy and D1+ dissection that was treated with percutaneous drainage and conservative management.

  9. Effects of Different Operative Procedures on the Digestive and Nutritional Status of Patients Treated with a Gastrectomy for Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    Han Liang; Xishan Hao

    2006-01-01

    Postgastrectomy syndromes evoked by the loss of several gastric functions after total or subtotal gastrectomy are very common. Different kinds of reconstruction have been developed to overcome the problem. Patients with preservation of a duodenal passage and jejunal interposition with or without a pouch show a better quality of life and minimal symptoms postoperatively. A jejunal interposition with or without a pouch after proximal or distal subtotal gastrictomy seems to improve the nutritional condition and quality of life. The prognostic nutritional index (PNI), Visick score, Spitzer index and the European Organization for Research and Treatment of Cancer (EORTC) questionnaire (QLQ-C30) are available to evaluate the quality of life and nutritional status after gastrectomy.

  10. Focal fat deposition developed in the segment IV of the liver following gastrectomy mimicking a hepatic metastasis: Two case reports

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Beom Seok; Lim, Joon Seok; Kim, Myeong Jin; Kim, Ki Whang; Hyung, Woo Jin [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    2012-10-15

    We present two cases of focal fat deposition developed at the posterior area of the segment IV in the liver, following gastrectomy in patients with gastric cancer. There was no focal lesion in this area of the liver at preoperative computed tomography (CT) in both cases, and the aberrant right gastric vein (ARGV) was found on the retrospective review of this CT. After gastrectomy, a focal, low attenuating lesion was developed in this area on a follow up CT in both cases, which was confirmed as a focal fat deposition, by other imaging studies. In addition to its typical imaging findings, confirmation of the presence of the ARGV also supported this lesion to be a focal fat deposition. Furthermore, understanding of our cases may be of help to prevent us from unnecessary invasive procedures, such as liver biopsy.

  11. Simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach.

    Science.gov (United States)

    Zhu, Qian-Lin; Zheng, Min-Hua; Feng, Bo; Lu, Ai-Guo; Wang, Min-Liang; Li, Jian-Wen; Hu, Wei-Guo; Zang, Lu; Mao, Zhi-Hai; Dong, Feng; Ma, Jun-Jun; Zong, Ya-Ping

    2008-06-07

    Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity, a shorter treatment time, and similar outcomes. However, simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature. Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort. He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected. The operation time was 270 min and the estimated blood loss was 120 mL. The patient required parenteral analgesia for less than 24 h. Flatus was passed on postoperative day 3, and a solid diet was resumed on postoperative day 7. He was discharged on postoperative day 13. With the advances in laparoscopic technology and experience, simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.

  12. Percutaneous placement of self-expandable metallic stents in patients with obstructive janudice secondary to metastalic gastric cancer after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Seo, In Ho; Yu, Jung Rim; Mok, Young Jae; Oh, Joo Hyeong [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kwon, Se Hwan [Dept. of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Kim, Sam Soo [Dept. of Radiology, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Kim, Seung Kwon [Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

    2013-10-15

    To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

  13. Role of the duodenum in regulation of plasma ghrelin levels and body mass index after subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Hai-Tao Wang; Qi-Cheng Lu; Qing Wang; Rong-Chao Wang; Yun Zhang; Hai-Long Chen; Hong Zhao; Hai-Xin Qian

    2008-01-01

    AIM: To investigate the role of the duodenum in the regulation of plasma ghrelin levels and body mass index (BMI), and the correlation between them after subtotal gastrectomy.METHODS: Forty-two patients with To-1No-1M0 gastric cancer were divided into two groups after gastrectomy according to digestive reconstruction pattern,Billroth I group (n = 23) and Billroth Ⅱ group (n = 19).Ghrelin levels were determined with radioimmunoassay (RIA) before and on d 1, 7, 30 and 360 after gastrectomy,and BMI was also measured.RESULTS: The two groups had identical postoperative trends in ghrelin alterations during the early stage, both decreasing sharply to a nadir on d 1 (36.7% vs 35.7%),then markedly increasing on d 7 (51.0% vs 51.1%). On d 30, ghrelin levels in the Billroth I group were slightly higher than those in the Billroth Ⅱ group. However,those of the Billroth I group recovered to 93.6% on d 360, which approached, although lower than, the preoperative levels, and no statistically significant difference was observed. Those of the Billroth Ⅱ group recovered to only 81.6% and manifested significant discrepancy with preoperative levels (P = 0.033).Compared with preoperative levels, ghrelin levels of the two groups decreased by 6.9% and 18.4% and BMI fell by 3.3% and 6.4%, respectively. The linear regression correlations were revealed in both groups between decrease of ghrelin level and BMI (R12 = 0.297, P = 0.007;R22 = 0.559, P < 0.001).CONCLUSION: Anatomically and physiologically, the duodenum compensatively promotes ghrelin recovery and accordingly enhances BMI after gastrectomy.Regarding patients with insufficient ghrelin secretion,ghrelin is positively associated with BMI.

  14. The Quality of Life of Gastric Cancer Patients with and without Duodenal Passage Reconstructions after Total Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Dongsheng Li; Huimian Xu

    2005-01-01

    OBJECTIVE To evaluate the Quality of Life of the patients who received a total gastrectomy with different kinds of reconstruction methods.METHODS Patients who received a total gastrectomy between May 1999 to May 2003 were followed-up via questionnaires. Fifty-nine who were alive more than 2 years with no sigh of recurrence were enrolled in this study. The patients were divided into 2 groups as follows: a group treated with reconstruction with a duodenal passage after total gastrectomy (gastric substitute, GS); and a group receiving reconstruction without duodenal passage after total gastrectomy (Jejenal pouch, JP). Follow-up feedback data of 14 items from the patients were analyzed, comparing the Quality of Life (QOL) between the 2 groups.RESULTS Six months after operation, the most common symptoms of all patients were reflux and loss of body weight, but there was no statistically significant differences in the 14 items related to the special post-operation symptoms between the 2 groups. At 12 months after the operations,there were significant differences between the 2 groups in body weight (P=0.01), eating time (P=0.034<0.05), and frequency of food intake (P=0.040<0.05); At 24 months after the operations, the only difference between the 2 groups was body weight gain (P=0.025<0.05). The JP group was better than the GS group.CONCLUSION The JP reconstruction pattern is superior to a simple GS in gain of body weight, volume of food intake and frequency of food intake, soon after the operation.

  15. Billroth II with Braun Enteroenterostomy Is a Good Alternative Reconstruction to Roux-en-Y Gastrojejunostomy in Laparoscopic Distal Gastrectomy

    OpenAIRE

    Long-Hai Cui; Sang-Yong Son; Ho-Jung Shin; Cheulsu Byun; Hoon Hur; Sang-Uk Han; Yong Kwan Cho

    2017-01-01

    Background. Although Billroth II (BII) reconstruction is simpler and faster than Billroth I or Roux-en-Y (RY) reconstruction in patients undergoing totally laparoscopic distal gastrectomy (TLDG), BII reconstruction is associated with several complications, including more severe bile reflux. BII Braun anastomosis may be a better alternative to RY reconstruction. Methods. This retrospective study included 56 consecutive patients who underwent TLDG for gastric cancer, followed by BII Braun or RY...

  16. [Effectiveness of chemoradiotherapy for a patient with local recurrence of advanced gastric cancer followed by curable gastrectomy].

    Science.gov (United States)

    Natsume, Soichiro; Iwasaki, Yoshiaki; Yajima, Kazuhito; Yuu, Ken; Oohinata, Ryouki; Ishiyama, Satoshi; Takahashi, Keiichi; Maeda, Yoshiharu

    2014-11-01

    We report here the effectiveness of chemoradiotherapy for a patient with local recurrence followed by curable gastrectomy. A 57-year-old man presented with a history of total gastrectomy with distal pancreatectomy and splenectomy, D2 lymphadenectomy, and Roux-en-Y reconstruction for advanced gastric cancer arising from the cardia. Esophageal intramural metastasis and lymph node metastasis around the right recurrent nerve were detected by chest-abdominal computed tomography and gastrointestinal endoscopy 27 months after the initial gastrectomy. Stable disease was achieved following 7 courses of chemotherapy using S-1 plus CDDP. Concurrent chemoradiotherapy including administration of S-1 and radiation of total 50 Gy (2 Gy/25 Fr) was selected for local tumor control. The patient was not able to eat solid food because of esophageal stenosis from regrowth of intramural metastasis of the esophagus 60 months after the chemotherapy. A WallFlex™ Duodenal Stent was placed to improve the dysphagia 67 months after chemotherapy. The patient died from recurrence of gastric cancer 69 months after completion of the initial chemotherapy and 2 months after the stent insertion.

  17. Fracture of a titanium sleeve-encased third-generation ceramic liner in a modern THA.

    Science.gov (United States)

    Chotai, Pranit N; Su, Edwin P

    2011-10-01

    Due to their excellent tribology, ceramics are increasingly used for total hip arthroplasty (THA) in young patients. Fracture rates for contemporary ceramics range from 0% to 0.004%. Recently, ceramic liners are encased in a titanium sleeve to further decrease the chances of fracture. We encountered 1 case of a metal-encased acetabular liner fracture in a ceramic-on-ceramic articulation in a series of 764 hips. Our literature review revealed no reports of metal-encased ceramic liner fracture. A 60-year-old woman presented 27 months after a bilateral ceramic-on-ceramic THA. She reported mechanical grinding and clicking from the left hip on extension. There was no history of trauma or fall. Examination revealed a nonantalgic gait and audible-palpable crepitations on the left hip. Range of motion of the left hip was intact with no subluxation. Radiographs revealed fractured ceramic insert and an excessively anteverted socket on the left side. Intraoperative findings revealed gross impingement in the form of indentation of the metal femoral neck against the elevated metal rim encasing the liner. Revision THA was performed using an uncemented polyethylene liner while retaining the well-fixed cup and stem. The Harris Hip Score at 4.5-year follow-up was 100, with no evidence of osteolysis or polyethylene wear.

  18. Comparison of Quality of Life and Nutritional Status in Gastric Cancer Patients Undergoing Gastrectomies.

    Science.gov (United States)

    Lim, Hee-Sook; Cho, Gyu-Seok; Park, Yoon-Hyung; Kim, Soon-Kyung

    2015-07-01

    The aim of this study was to compare the quality of life (QoL) depending on the postoperative survival period or nutritional status in gastric cancer patients. Surviving gastric cancer patients (n = 222) after the gastrectomy were included in the study at Soonchunhyang University Bucheon Hospital from April 2010 to August 2012. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and a gastric cancer-specific module, the EORTC QLQ-STO22, were used to assess the QoL. The postoperative survival period of the patients fell into two groups; the less-than-1-year group or the more-than-1-year group, and the nutritional status of the patients fell into three groups by a score of patient generated-subjective global assessment (SGA)-A, B, and C. As a result, the rate of malnutrition was 34.5% in the less-than-1-year group and 19.8% in the more-than-1-year group, respectively. Score for the fatigue (p = 0.006), loss of appetite (p = 0.002), reflux (p = 0.027) and body image (p = 0.004) in which the QoL was significantly lower in the less-than-1-year group than in the more-than-1-year group. The score of QoL according to the nutritional status of all subjects, overall health status (p = 0.043), physical functioning (p = 0.016), fatigue (p = 0.006), pain (p = 0.028), loss of appetite (p = 0.017), reflux (p = 0.003), eating restriction (p = 0.002), anxiety (p = 0.010), and body image (p = 0.001) was significantly lower in the SGA-C group than in other SGA groups. These results suggest that the nutritional status of the gastrectomy patients with stomach cancer may impact on their QoL. It is necessary to to develop nutritional intervention to improve QoL in gastric cancer patients with postoperative malnutrition.

  19. The effects of a prophylactic knee brace and two neoprene knee sleeves on the performance of healthy athletes: a crossover randomized controlled trial.

    Science.gov (United States)

    Mortaza, Niyousha; Ebrahimi, Ismail; Jamshidi, Ali Ashraf; Abdollah, Vahid; Kamali, Mohammad; Abas, Wan Abu Bakar Wan; Osman, Noor Azuan Abu

    2012-01-01

    Knee injury is one of the major problems in sports medicine, and the use of prophylactic knee braces is an attempt to reduce the occurrence and/or severity of injuries to the knee joint ligament(s) without inhibiting knee mobility. The aim of the present study was to examine the effect of one recently designed prophylactic knee brace and two neoprene knee sleeves upon performance of healthy athletes. Thirty-one healthy male athletes (age = 21.2 ± 1.5) volunteered as participants to examine the effect of prophylactic knee brace/sleeves on performance using isokinetic and functional tests. All subjects were tested in four conditions in a random order: 1. nonbraced (control) 2. using a neoprene knee sleeve 3. using a knee sleeve with four bilateral metal supports and 4. using a prophylactic knee brace. The study design was a crossover, randomized, controlled trial. Subjects completed single leg vertical jump, cross-over hop, and the isokinetic knee flexion and extension (at 60, 180, 300°/sec). Data were collected from the above tests and analyzed for jump height, cross-over hop distance, peak torque to body weight ratio and average power, respectively. Comparisons of these variables in the four testing conditions revealed no statistically significant difference (p>0.05). The selected prophylactic brace/sleeves did not significantly inhibit athletic performance which might verify that their structure and design have caused no complication in the normal function of the knee joint. Moreover, it could be speculated that, if the brace or the sleeves had any limiting effect, our young healthy athletic subjects were well able to generate a mean peak torque large enough to overcome this possible restriction. Further studies are suggested to investigate the long term effect of these prophylactic knee brace and sleeves as well as their possible effect on the adjacent joints to the knee.

  20. The effects of a prophylactic knee brace and two neoprene knee sleeves on the performance of healthy athletes: a crossover randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Niyousha Mortaza

    Full Text Available Knee injury is one of the major problems in sports medicine, and the use of prophylactic knee braces is an attempt to reduce the occurrence and/or severity of injuries to the knee joint ligament(s without inhibiting knee mobility. The aim of the present study was to examine the effect of one recently designed prophylactic knee brace and two neoprene knee sleeves upon performance of healthy athletes. Thirty-one healthy male athletes (age = 21.2 ± 1.5 volunteered as participants to examine the effect of prophylactic knee brace/sleeves on performance using isokinetic and functional tests. All subjects were tested in four conditions in a random order: 1. nonbraced (control 2. using a neoprene knee sleeve 3. using a knee sleeve with four bilateral metal supports and 4. using a prophylactic knee brace. The study design was a crossover, randomized, controlled trial. Subjects completed single leg vertical jump, cross-over hop, and the isokinetic knee flexion and extension (at 60, 180, 300°/sec. Data were collected from the above tests and analyzed for jump height, cross-over hop distance, peak torque to body weight ratio and average power, respectively. Comparisons of these variables in the four testing conditions revealed no statistically significant difference (p>0.05. The selected prophylactic brace/sleeves did not significantly inhibit athletic performance which might verify that their structure and design have caused no complication in the normal function of the knee joint. Moreover, it could be speculated that, if the brace or the sleeves had any limiting effect, our young healthy athletic subjects were well able to generate a mean peak torque large enough to overcome this possible restriction. Further studies are suggested to investigate the long term effect of these prophylactic knee brace and sleeves as well as their possible effect on the adjacent joints to the knee.

  1. Comparative study of laparoscopic vs open gastrectomy in gastric cancer management

    Institute of Scientific and Technical Information of China (English)

    Giuseppe S Sica; Edoardo Iaculli; Livia Biancone; Sara Di Carlo; Rosa Scaramuzzo; Cristina Fiorani; Paolo Gentileschi; Achille L Gaspari

    2011-01-01

    AIM: To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrectomy in a single unit.METHODS: From February 2000 to September 2004, all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial. Primary endpoint was cancer-related survival and secondary endpoints were overall survival, evaluation of surgical complications and mortality.RESULTS: Fifty-eight patients were enrolled. Forty-seven patients were followed-up (range 11-103, median 38 mo). Four patients were lost at follow up. Twenty-two patients underwent a laparoscopic gastric surgery (LGS) and 25 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate (50% vs 52%, P = 1), and 5 years overall mortality rate (54.5% vs 56%, P = 1). Accordingly, cancer-related and overall survival probability by Kaplan-Meier method showed comparable results (P = 0.81 and P = 0.83, respectively). We found no differences in surgical complications in the 2 groups. There was no conversion to open surgery in this series.CONCLUSION: LGS is as effective as OGS in the management of advanced gastric cancer. However LGS cannot be recommended routinely over OGS for the treatment of advanced gastric cancer.

  2. Nutritional risk index as a predictor of postoperative wound complications after gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Cheong Ah Oh; Dae Hoon Kim; Seung Jong Oh; Min Gew Choi; Jae Hyung Noh; Tae Sung Sohn; Jae Moon Bae; Sung Kim

    2012-01-01

    AIM:To investigate the correlation between the nutritional risk index (NRI) and postoperative wound complications.METHODS:From January 2008 through June 2008,669 patients who underwent curative gastrectomy for gastric cancer were included in a retrospective study.Medical records of consecutive patients were collected and analyzed to determine postoperative wound complication rates.The NRI was assessed on the fifth postoperative day and other possible risk factors for the incidence of wound complications were analyzed to identify the factors affecting postoperative wound complications.Patients with other postoperative complications were excluded from the study.RESULTS:On the 5th postoperative day,the NRI showed a malnutrition rate of 84.6% among postoperative patients.However,postoperative wound complications occurred in only 66/669 (9.86%) patients.Of the patients with wound complications,62/66 (94%)belonged to the malnourished group (NRI < 97.5),and 4/66 (6%) patients to the non-malnourished group (NRI ≥ 97.5).The only factor correlated with wound complications was the NRI on the 5th postoperative day (odds ratio of NRI ≥ 97.5 vs NRI < 97.5:0.653; 95%confidence interval:0.326-0.974; P =0.014) according to univariate analysis as well as multivariate analysis.CONCLUSION:This study suggests that malnutrition immediately after surgery may play a significant role in the development of wound complications.

  3. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Min-Chan Kim; Ghap-Joong Jung; Hyung-Ho Kim

    2005-01-01

    AIM: To evaluate the nature of the "learning curve" for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer. METHODS: The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated. RESULTS: After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (<200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups. CONCLUSION: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

  4. Comparison of effects of different weight loss education modes in postoperative patients with laparoscopic sleeve gas-trectomy%不同减肥教育方式对腹腔镜袖状胃切除减肥术后患者的影响

    Institute of Scientific and Technical Information of China (English)

    赵冬琴; 姜小良; 张华

    2016-01-01

    Objective To study the effect of individualized and collectivization weight loss education on postoperative body mass index(BMI),blood lipid and compliance behavior in the patients undergoing laparoscopic sleeve gastrectomy. Methods Fifty-four cases of laparoscopic sleeve gastrectomy for conducting weight loss in the First Affiliated Hospital of Chongqing Medical University from April 2013 to September 2015 were chosen and divided into the individualized education group (28 cases) and collectivization education group(26 cases) according to the operation order. BMI,blood lipid and compliance behavior before education and at 6 months after education were observed in the two groups and the causes were analyzed. Results BMI,waist circumference(WC) and blood lipid levels in the two groups were significantly lower than those before education,but the decrease of these 3 indexes in the individualize group were more significantly than that in the collectivization education group with statisti cal difference(P<0.05). In the aspect of compliance behavior,the compliance behavior effect after education in the two groups was better than that before education , but the compliance behavior after 6-month education in the individualized education group was superior to the collectivization education group,the difference was statistically significant(P<0.05). Conclusion Implementing the individualized education in the postoperative patients after laparoscopic sleeve gastrectomy can effectively control the body weight level and blood lipid level,increases the compliance behavior and has more superiority than the traditional collectivization education model.%目的:比较分析个体化与集体化减肥教育对行腹腔镜袖状胃切除术减肥患者术后体质量指数(BMI)、血脂及遵医行为的影响。方法选取2013年4月至2015年9月在重庆医科大学附属第一医院行腹腔镜袖状胃切除术减肥的患者54例。按手术先后次序,将其随

  5. Wear Resistance of Piston Sleeve Made of Layered Material Structure: MMC A356R, Anti-Abrasion Layer and FGM Interface

    Directory of Open Access Journals (Sweden)

    Hernik Szymon

    2016-09-01

    Full Text Available The aim of this paper is the numerical analysis of the one of main part of car engine – piston sleeve. The first example is for piston sleeve made of metal matrix composite (MMC A356R. The second improved material structure is layered. Both of them are comparison to the classical structure of piston sleeve made of Cr-Ni stainless steel. The layered material structure contains the anti-abrasion layer at the inner surface of piston sleeve, where the contact and friction is highest, FGM (functionally graded material interface and the layer of virgin material on the outer surface made of A356R. The complex thermo-elastic model with Archard's condition as a wear law is proposed. The piston sleeve is modelling as a thin walled cylindrical axisymmetric shell. The coupled between the formulation of thermo-elasticity of cylindrical axisymmetric shell and the Archard’s law with functionally changes of local hardness is proposed.

  6. 胃癌合并2型糖尿病患者行腹腔镜与开腹全胃切除术的疗效比较%Curative effect of laparoscopic gastrectomy and total gastrectomy for patients with gastric cancer accompanying type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    滕达; 李松岩; 宁宁; 杜晓辉

    2013-01-01

    Objective To find out the best procedure for patients with gastric cancer accompanying type 2 diabetes mellitus (DM) by comparing the curative effect of laparoscopic gastrectomy and laparoscopic total gastrectomy. Methods Clinical data about 76 patients with gastric cancer accompanying DM admitted to our hospital from June 2008 to June 2010 were retrospectively analyzed. The patients were divided into laproscopic gastrectomy group (n=38) and laproscopic total gastrectomy group (n=38). The curative effect of the two procedures was compared. Results The effective rate was 73.7%and 57.9%for the laparoscopic total gastrectomy group and laparoscopic gastrectomy group, respectively (P<0.05). The incision size was smaller, blood loss was less, the postoperative anal exhaust time and feeding time were shorter, the number of white blood cells and neutrophils was lower in laparoscopic total gastrectomy group than in laparoscopic gastrectomy group (P <0.05). Conclusion The curative effect of laparoscopic total gastrectomy is better than that of laparoscopic gastrectomy for patients with gastric cancer accompanying type 2 DM.%  目的比较腹腔镜和开腹手术治疗胃癌合并2型糖尿病患者的临床疗效,寻求最佳的治疗方法.方法以解放军总医院2008年6月-2010年6月治疗的76例胃癌合并糖尿病患者为研究对象,对其临床资料进行回顾性分析.开腹手术组(open surgery,OS)38例;腹腔镜手术组(laparoscopic surgery,LAP)38例.对两组手术方法及临床疗效等进行比较.结果腹腔镜手术组有效率为73.7%,开腹手术组为57.9%,差异有统计学意义(P<0.05);在切口大小、出血量、术后肛门排气时间、进食时间及白细胞和中性粒细胞计数等数据进行比较,腹腔镜手术组均优于开腹组(P<0.05).结论在胃癌合并2型糖尿病患者的治疗中,腹腔镜全胃切除术较开腹手术疗效显著.

  7. Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection

    Directory of Open Access Journals (Sweden)

    Anita Joselyn

    2015-01-01

    Full Text Available Purpose: One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection. Materials and Methods: With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure. Results: This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024. Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS. No difference was noted in the postoperative pain scores. Conclusion: Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

  8. Clinical experience of double sleeve lobectomy of the bronchus and the pulmonary artery in patients with central lung cancer

    Institute of Scientific and Technical Information of China (English)

    Yukang Kuang; Changying Guo; Laiduo Zeng; Dongsheng Wang; Binglin Yin; Jiufa Wu; Jian Huang; Zhisheng He; Jianfeng Zhu; Feng Jiang

    2013-01-01

    Objective: The aim of our study was to introduce the surgical method and evaluate the efficacy of double sleeve lobectomy of the bronchus and the pulmonary artery in treatment for the central lung cancer. Method: From March 1995 to October 2010, double sleeve lobectomy of the bronchus and the pulmonary artery was performed in 45 cases with central lung cancer that involved the bronchial opening of an upper lobe of the lungs or the main bronchus and pulmonary artery but didn't involve any lower lobes. Among them, left upper lobectomy was performed in 37 cases, right medium-upper lobectomy was performed in 6 cases and right upper lobectomy was performed in 2 cases. Results: Postoperative complications were found in 12 cases. Among them, 3 cases were arrhythmia, 1 case was acute heart failure, 6 cases were obstructive pneumonia and pulmonary atelectasis, 2 cases were bronchial anastomotic fistula. Two cases died of cerebral infarction and massive hemoptysis respectively. Thirty-one cases were squamous carcinoma, 7 cases were adenocarcinoma, 4 cases were small cell lung cancer, 1 case was adenosquamous carcinoma, 1 case was sarcomatoid carcinomas, 1 case was mucinous adenocarcinoma. Ten cases were T3N0M0, 11 cases were T3N1M0, 17 cases were T3N2M0, 2 cases were T4N1M0, 5 cases were T4N2M0. The 1-year, 3-year, 5-year survival rates were 84.4% (38/45), 51.7% (15/29), 53.8% (7/13) respectively. Conclusion: The double sleeve lobectomy of the bronchus and the pulmonary artery can maximumly reserve the normal lung tissues while removing tumors, and avoid pneumonectomy. The surgery was safe and effective, while it required a high technique.

  9. 腹腔镜肥胖外科临床应用指南(2008年版)

    Institute of Scientific and Technical Information of China (English)

    美国胃肠内镜外科医师学会; 沈莹莹

    2012-01-01

    [腹腔镜肥胖外科手术名词] 可调节胃束带术(adjustable gastric banding,AGB);胆胰转流术(biliopancreatic diversion,BPD);十二指肠转位术(duodenal switch,DS);Roux-en-Y胃旁路术(Roux-en-Y gastric bypass,RGB);腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG).

  10. PubMed Included a Bibliometric Analysis of the Gastrectomy%PubMed收录胃切除术相关文献的计量学分析

    Institute of Scientific and Technical Information of China (English)

    麻立民; 王文亮

    2015-01-01

    On PubMed indexed nearly 10 years gastrectomy literature year, country, journal source, prolific author, main keyword statistics, and analyze the data in order to identify relevant literature gastrectomy distribution characteristics and research status.%对PubMed收录的近10年胃切除术相关文献的年份、国别、期刊来源、多产作者、主要主题词进行统计,并对有关数据进行分析,以明确胃切除术相关文献分布特点和研究现状。

  11. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22 patients received enhanced recovery programme (ERAS management and rest twenty-five (n = 25 conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h when compared to conventional group (140 ± 28 h. ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h. There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43 g/L vs. (73.07 ± 19.32 g/L, d3 (126.10 ± 18.62 g/L vs. (160.72 ± 26.18 g/L]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

  12. Distal gastrectomy in pancreaticoduodenectomy is associated with accelerated gastric emptying, enhanced postprandial release of GLP-1, and improved insulin sensitivity

    DEFF Research Database (Denmark)

    Harmuth, Stefan; Wewalka, Marlene; Holst, Jens Juul

    2014-01-01

    OBJECTIVE: This study aims to investigate the relationship between gastric emptying, postprandial GLP-1 and insulin sensitivity after pancreaticoduodenectomy (PD). BACKGROUND: Abnormal glucose regulation is highly prevalent in patients with pancreatic neoplasm and resolves in some after PD......, the cause of which is unclear. The procedure is carried out with pylorus preservation (PPPD) or with distal gastrectomy (Whipple procedure). Accelerated gastric emptying and ensuing enhanced release of glucagon-like peptide-1 (GLP-1) conceivably play a role in glucose metabolism after PD. It was the purpose...

  13. Total gastrectomy for rare refractory gastroparesis in patient with syringomyelia: A good impact on quality of life

    Directory of Open Access Journals (Sweden)

    Maurizio Zizzo

    2015-12-01

    We report a case of a 67-year-old woman with a history of pain in the back-lumbar spine and lower limbs, paresthesia and urinary incontinence. MRI revealed syringomyelia, extended from T3 to the medullary cone. Neurological picture was worsened by progressive and increasingly debilitating gastrointestinal symptoms refractory to dietary changes and medical treatment. Blood tests, gastrointestinal investigations and imaging were all normal apart from scintigraphy which confirmed delayed gastric emptying. The neurological symptoms disappeared after removal of an hemangioblastoma of the medullary cone. The persistent gastroparesis was treated by total gastrectomy with complete resolution of the patient's gastrointestinal symptoms.

  14. The development of a small bowel volvulus in the early postoperative period following a distal gastrectomy: report of a case.

    Science.gov (United States)

    Sakamoto, T; Miyata, M; Nakamuro, M; Izukura, M; Kamiike, W; Matsuda, H

    1994-01-01

    A 51-year-old Japanese man who underwent a standard distal gastrectomy for cancer of the stomach developed abdominal pain when oral intake was commenced on the 6th postoperative day after an uneventful postoperative course. Complete obstruction of the jejunum led to a sudden deterioration in his general condition and a laparotomy was performed, revealing counterclockwise rotation of the mesenterium. The necrotic portion of the small intestine was removed, while 10 cm of the upper jejunum and 100 cm of the terminal ileum were preserved. His second postoperative course was uneventful apart from the development of "intestinal hurry," which is now under medical control 9 months after his second laparotomy.

  15. Effect on changes of blood coagulation function, cytokines and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jia-Qi Liu; Shao-Jun Yang; Jie-Qing Chen; Ru-Kui Su; Zhong Huang; Yin-Zhuo Qi

    2017-01-01

    Objective:To explore the changes of coagulation function, cytokines and T lymphocyte in patients undergoing laparoscopic radical gastrectomy for gastric cancer and its clinical significance.Methods: 40 cases of laparoscopic radical gastrectomy for gastric cancer patients and 40 cases of open radical gastrectomy for gastric cancer patients in our hospital were selected to detect and investigate the perioperative coagulation function [APTT (activated partial thromboplastin time), FIB (fibrinogen), and PLT (platelet)], cytokines [CRP (C reactive protein), IL-6 (IL-6) and TNF-alpha (Tumor necrosis factor-alpha)] and T lymphocytes (CD4+, CD8+ and CD4+/CD8+) changes and clinical meaning of patients in the two groups.Results: The coagulation function related indicators, cytokines and T lymphocytes of the two groups before treatment did not change significantly (P>0.05). 1 d after operation, blood coagulation, TNF-alpha, CD4+ and CD4+/CD8+ levels were significantly lower than that before operation in two groups of patients (P<0.05), while IL-6, CRP and CD8+ were significantly higher than that before the operation (P<0.05), and the index change in open group was more obvious. 3 d after surgery, the APTT, IL-6, CRP, CD4+, CD8+ and PLT levels in two group patients were significantly lower than that 1 d after surgery, while FIB, TNF-alpha and CD4+/CD8+ were significantly higher than that 1 d after surgery; blood coagulation index, TNF-alpha and CD4+ and CD4+/CD8+ were significantly lower in the laparotomy group patients than in laparoscopic group, while IL-6, CRP and CD8+ were significantly higher than the laparoscopic group (P<0.05). 5 d after operation, the APTT, TNF-alpha, FIB, CD4+, CD4+/CD8+ and PLT in two groups were significantly higher than that 3 d after surgery (P<0.05), while IL-6, CRP and CD8+ levels were significantly lower than that of 3 d after surgery (P<0.05); blood coagulation index, TNF-alpha and CD4+ and CD4+/CD8+ in the laparotomy group patients were

  16. Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy

    Institute of Scientific and Technical Information of China (English)

    De-Chuan Chan; Kuo-Liang Shen; Yao-Chi Liu; Cheng-Jueng Chen; Jyh-Cherng Yu; Heng-Cheng Chu; Fa-Chang Chen; Teng-Wei Chen; Huan-Fa Hsieh; Tzu-Ming Chang

    2005-01-01

    AIM: To assess the efficacy of metoclopramide (Met) for prevention of prolonged post-operative ileus in advanced gastric cancer patients undergoing D2 gastrectomy and intra-peritoneal chemotherapy (IPC).METHODS: Thirty-two advanced gastric cancer patients undergoing D2 gastrectomy and IPC were allocated to two groups. Sixteen patients received Met immediately after operation (group A), and 16 did not (group B). Another 16 patients who underwent D2 gastrectomy without IPC were enrolled as the control group (group C). All patients had received epidural pain control. The primary endpoints were time to first post-operative flatus and time until oral feeding with a soft diet without discomfort. Secondary endpoints were early complications during hospitalization.RESULTS: Gender, the type of resection, operating time,blood loss, tumor status and amount of narcotics were connparable in the three groups. However, the group C patients were older than those in groups A and B (67.5±17.7 vs 56.8±13.2, 57.5±11.7 years, P= 0.048). First bowel flatus occurred after 4.35±0.93 d in group A, 4.94±1.37 d in group B, and 4.71±1.22 d in group C (P>0.05). Oral feeding of a soft diet was tolerated 7.21±1.92 d after operation in group A, 10.15±2.17 d in group B, and 7.53±1.35 d in group C(groups A and C vsgroup B, P<0.05). There was no significant difference in respect to the first flatus among the three groups. However, the time of tolerating oral intake with soft food in groups A and C patients was significantly shorter than that in group B patients. Levels of C-reactive protein (CRP) were significantly lower in group C and there was a more prominent and prolonged response in CRP level in patients undergoing IPC. The incidence of post-operative complications was similar in the three groups except for prolonged post-operative ileus. There was no increased risk of anastomotic leakage in patients receiving Met.CONCLUSION: The results suggest that a combination of intravenous

  17. [A case of S-1/CDDP chemotherapy for inoperable advanced gastric cancer which led to gastrectomy with histological complete response].

    Science.gov (United States)

    Kobayashi, Kenji; Tanizaki, Keiko; Aoki, Taro; Takachi, Kou; Nishioka, Kiyonori; Matsumoto, Takashi; Komori, Takamichi; Chono, Teruhiro; Kato, Aya; Hyuga, Satoshi; Watanabe, Risa; Uemura, Yoshio

    2011-11-01

    As the treatment for inoperable advanced gastric cancer, S-1/CDDP combination therapy (SP chemotherapy) has become a standard treatment. In our hospital, a second course of chemotherapy was performed on an outpatient basis in order to improve a traditional QOL. In this case, it showed remarkable effects in 15 months after starting chemotherapy. Then gastrectomy was performed. Histological findings of the resected specimens confirmed pCR in all tumors. We report on progress of this case and explain about the ingenuity of SP chemotherapy.

  18. HYBASE : HYperspectral BAnd SElection

    NARCIS (Netherlands)

    Schwering, P.B.W.; Bekman, H.H.P.T.; Seijen, H.H. van

    2009-01-01

    Band selection is essential in the design of multispectral sensor systems. This paper describes the TNO hyperspectral band selection tool HYBASE. It calculates the optimum band positions given the number of bands and the width of the spectral bands. HYBASE is used to assess the minimum number of spe

  19. Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Han-Cheng Liu; Yan-Bing Zhou; Dong Chen; Zhao-Jian Niu; Yang Yu

    2012-01-01

    AIM:To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy.METHODS:Within 24 h of intensive care unit management,patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L.Resting energy expenditure (REE),respiratory quotient (RQ),resting energy expenditure per kilogram (REE/kg),and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system.The changes in body composition were analyzed by multi-frequency bioimpedance analysis.Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance.RESULTS:Sixty patients were enrolled.Compared with preoperative baseline,postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05,respectively) on postoperative days 1 and 3 in the IIT group.Meanwhile the concentration of total protein,albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05,respectively).Compared with the CIT group,IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg,P =0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg,P =0.013); and decreased the Ln-HOMA-IR score (P =0.019,0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P

  20. Surgical short-term outcomes of robotic gastrectomy versus laparoscopic gastrectomy: a case-control study%达芬奇机器人与腹腔镜胃癌手术近期疗效的对照研究

    Institute of Scientific and Technical Information of China (English)

    刘驰; 唐波; 郝迎学; 石彦; 曾冬竹; 罗华星; 赵永亮; 钱锋; 余佩武

    2013-01-01

    目的 对比达芬奇机器人手术系统与腹腔镜手术治疗胃癌的临床近期疗效,以评估达芬奇机器人手术系统在治疗胃癌中的安全性及可行性.方法 采用非随机对照设计,按照患者自愿的原则选择手术方式,分析2010年3月至2012年3月在本中心进行胃癌根治术患者的临床资料,其中使用达芬奇机器人手术系统进行胃癌根治术48例,以患者年龄、性别、BMI、肿瘤分期为协变量使用最邻配比法配对腹腔镜组手术患者48例.对比分析2组患者的手术指标、病例指标及术后短期疗效指标.2组患者手术均由同年资医师顺利完成.结果 与腹腔镜组比较,达芬奇机器人手术组术中出血量更少[107.8±55.9)mL vs(132.7±61.5) mL,P=0.041],淋巴结清扫更彻底[(34.7±5.2)vs(32.5±4.7),P=0.026],但手术时间更长[(238.0±29.6) min vs (221.5 ±33.1)min,P=0.011].结论 对比腹腔镜手术系统治疗胃癌,达芬奇机器人手术系统术中对患者造成的损伤更小,肿瘤清扫更为彻底.因此,使用达芬奇机器人手术系统治疗胃癌安全、可行.%Objective To compare the short-term surgical outcomes of robotic gastrectomy with laparoscopic gastrectomy for gastric cancer in order to evaluate the safety and feasibility of robotic surgery system.Methods Clinical data of 48 patients undergoing robotic gastrectomy in our department from March 2010 to March 2012 were collected,and 48 patients receiving laparoscopic gastrectomy during the same period served as control.There was no significant difference in the age,sex,BMI and cancer stage between the 2 groups.All surgery was performed successfully by qualified surgeons with same years of experience.The operative indexes and short-term outcomes were compared between the 2 groups.Results Compared with the laparoscopic groups,the robotic group had less intraoperative blood loss (107.8±55.9 vs 132.7 ±61.5 mL,P =0.041),larger number of lymph node dissection (34.7 ± 5

  1. Simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach

    Institute of Scientific and Technical Information of China (English)

    Qian-Lin Zhu; Feng Dong; Jun-Jun Ma; Ya-Ping Zong; Min-Hua Zheng; Bo Feng; Ai-Guo Lu; Min-Liang Wang; Jian-Wen Li; Wei-Guo Hu; Lu Zang; Zhi-Hai Mao

    2008-01-01

    Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity,a shorter treatment time,and similar outcomes.However,simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature.Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort.He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected.The operation time was 270min and the estimated blood loss was 120mL.The patient required parenteral analgesia for less than 24h.Flatus was passed on postoperative day 3,and a solid diet was resumed on postoperative day 7.He was discharged on postoperative day 13.With the advances in laparoscopic technology and experience,simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.

  2. Comparison of short outcomes between laparoscopic and experienced robotic gastrectomy: A meta-analysis and systematic review

    Directory of Open Access Journals (Sweden)

    Zhanyu Wang

    2017-01-01

    Full Text Available Objective: The purpose of this meta-analysis is to compare the short-term outcomes between experienced robotic gastrectomy (RG and laparoscopic gastrectomy (LG. Materials and Methods: We searched the PubMed, Springer Link, Elsevier, and Embase databases for articles published in English before June 2015 using an electronic literature search and including cross-referenced articles. Three studies were eligible for the meta-analysis. The outcomes evaluated were operation time, estimated blood loss, harvested lymph nodes, complication, and postoperative hospital stay. Results: Of a total of 562 patients, 165 underwent RG and 397 underwent LG. Operation time was significantly longer in the RG group [weighted mean difference (WMD: 21.49, 95% confidence interval (CI: 12.48-30.50, P< 0.00001. Estimated blood loss, harvested lymph nodes, complication, and postoperative hospital stay were similar between the two groups. Conclusion: Experienced RG has similar short-term outcomes to LG that is performed by sophisticated laparoscopic surgeons, except for operation time.

  3. Comparison of short outcomes between laparoscopic and experienced robotic gastrectomy: A meta-analysis and systematic review

    Science.gov (United States)

    Wang, Zhanyu; Wang, Yinghua; Liu, Yan

    2017-01-01

    OBJECTIVE: The purpose of this meta-analysis is to compare the short-term outcomes between experienced robotic gastrectomy (RG) and laparoscopic gastrectomy (LG). MATERIALS AND METHODS: We searched the PubMed, Springer Link, Elsevier, and Embase databases for articles published in English before June 2015 using an electronic literature search and including cross-referenced articles. Three studies were eligible for the meta-analysis. The outcomes evaluated were operation time, estimated blood loss, harvested lymph nodes, complication, and postoperative hospital stay. RESULTS: Of a total of 562 patients, 165 underwent RG and 397 underwent LG. Operation time was significantly longer in the RG group [weighted mean difference (WMD): 21.49, 95% confidence interval (CI): 12.48-30.50, P < 0.00001). Estimated blood loss, harvested lymph nodes, complication, and postoperative hospital stay were similar between the two groups. CONCLUSION: Experienced RG has similar short-term outcomes to LG that is performed by sophisticated laparoscopic surgeons, except for operation time. PMID:27251844

  4. Pancreatic fistula may be an important complication following spleen-preserving radical gastrectomy with dissection of No.10 and No.11 lymph nodes

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jun; ZHANG Zhong-tao; WANG Yu; WANG Kang-li

    2010-01-01

    @@ In recent years, spleen-preserving radical gastrectomy with dissection of No.10 and No.11 lymph nodes has been gradually accepted because of an improved understanding of immune function of the spleen in the perioperative period and for prognosis of gastric cancer.

  5. Quality of life after total vs distal gastrectomy with Roux-en-Y reconstruction: Use of the Postgastrectomy Syndrome Assessment Scale-45

    Science.gov (United States)

    Takahashi, Masazumi; Terashima, Masanori; Kawahira, Hiroshi; Nagai, Eishi; Uenosono, Yoshikazu; Kinami, Shinichi; Nagata, Yasuhiro; Yoshida, Masashi; Aoyagi, Keishiro; Kodera, Yasuhiro; Nakada, Koji

    2017-01-01

    AIM To investigate the detrimental impact of loss of reservoir capacity by comparing total gastrectomy (TGRY) and distal gastrectomy with the same Roux-en-Y (DGRY) reconstruction. The study was conducted using an integrated questionnaire, the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, recently developed by the Japan Postgastrectomy Syndrome Working Party. METHODS The PGSAS-45 comprises 8 items from the Short Form-8, 15 from the Gastrointestinal Symptom Rating Scale, and 22 newly selected items. Uni- and multivariate analysis was performed on 868 questionnaires completed by patients who underwent either TGRY (n = 393) or DGRY (n = 475) for stage I gastric cancer (52 institutions). Multivariate analysis weighed of six explanatory variables, including the type of gastrectomy (TGRY/DGRY), interval after surgery, age, gender, surgical approach (laparoscopic/open), and whether the celiac branch of the vagus nerve was preserved/divided on the quality of life (QOL). RESULTS The patients who underwent TGRY experienced the poorer QOL compared to DGRY in the 15 of 19 main outcome measures of PGSAS-45. Moreover, multiple regression analysis indicated that the type of gastrectomy, TGRY, most strongly and broadly impaired the postoperative QOL among six explanatory variables. CONCLUSION The results of the present study suggested that TGRY had a certain detrimental impact on the postoperative QOL, and the loss of reservoir capacity could be a major cause. PMID:28373774

  6. The Influence of Splenectomy Performed Simultaneously with Gastrectomy on Postoperative Complications in Patients with Gastric Cancer Undergoing Surgery with the Intention to Treat

    Directory of Open Access Journals (Sweden)

    Głuszek Stanisław

    2014-07-01

    Full Text Available Despite the growing understanding of the pathophysiological processes in the perioperative period and significant advancements in surgical techniques, operative treatment for gastric cancer remains a challenge for surgeons, especially because the primary procedure of total or nearly total gastrectomy must at times be extended by the resection of other organs.

  7. Study on Centrifugal Casting for Large Diameter Cast-steel Sleeve%大直径铸钢套筒的离心铸造研究

    Institute of Scientific and Technical Information of China (English)

    符寒光; 邢建东; 赵爱民

    2001-01-01

    The casting method for large diameter cast-steel sleeve in horizontal centrifugal casting machine was described. The process measures of decreasing gas hole and cast crack in sleeve were discussed. The cast-steel sleeve by centrifugal casting has the features of compacted and homogeneous microstructure, high technological yield and low machining allowance. The cost is decreased by more than 20% than that of cast-steel sleeve by c onventional static casting.%主要介绍了卧式离心铸造大直径铸钢套筒的方法,讨论了降低套筒气孔和铸造裂纹的工艺措 施,离心铸造铸钢套筒具有组织致密、均匀、工艺出品率高和铸件加工量少等特点,生产成 本比普通静态铸造降低20%以上,用作铝箔轧机的出口端卷筒,获 得了较好的效果。

  8. The Development of Diabetes after Subtotal Gastrectomy with Billroth II Anastomosis for Peptic Ulcer Disease

    Science.gov (United States)

    Chen, Chien-Hua; Hsu, Che-Ming; Lin, Cheng-Li

    2016-01-01

    Purpose A duodenal bypass after a Roux-en-Y gastric bypass operation for obesity can ameliorate the development of diabetes mellitus (DM). We attempted to determine the subsequent risk of developing DM after subtotal gastrectomy with Billroth II anastomosis (SGBIIA) for peptic ulcer disease (PUD). Methods We identified 662 patients undergoing SGBIIA for PUD between 2000 and 2011 from the Longitudinal Health Insurance Database as the study cohort, and we randomly selected 2647 controls from the peptic ulcer population not undergoing SGBIIA and were frequency-matched by age, sex, and index year for the control cohort. All patient cases in both cohorts were followed until the end of 2011 to measure the incidence of DM. We analyzed DM risk by using a Cox proportional hazards regression model. Results The patients who underwent SGBIIA demonstrated a lower cumulative incidence of DM compared with the control cohort (log-rank test, P < .001 and 6.73 vs 12.6 per 1000 person-y). The difference in the DM risk between patients with and without SGBIIA increased gradually with the follow-up duration. Age and sex did not affect the subsequent risk of developing DM, according to the multivariable Cox regression model. Nevertheless, the SGBIIA cohort exhibited a lower DM risk after we adjusted for the comorbidities of hypertension, hyperlipidemia, and coronary artery disease (adjusted hazard ratio (aHR): 0.56, 95% confidence interval (CI): 0.40–0.78). The incidence rate ratio (IRR) of DM in the SGBIIA cohort was lower than that in the control cohort for all age groups (age ≤ 49 y, IRR: 0.40, 95% CI: 0.16–0.99; age 50–64 y, IRR: 0.54, 95% CI: 0.31–0.96; age ≧ 65 y, IRR: 0.57, 95% CI: 0.36–0.91). Moreover, the IRR of DM was significantly lower in the SGBIIA cohort with comorbidities (IRR: 0.50, 95% CI: 0.31–0.78) compared with those without a comorbidity (IRR: 0.65, 95% CI: 0.40–1.04). Conclusion The findings of this population-based cohort study revealed that

  9. Optimized Parameters Study of Kimono Sleeve Gusset-insert Structure%连身袖袖裆结构的优化参数研究

    Institute of Scientific and Technical Information of China (English)

    崔静

    2014-01-01

    随着服装多元化的发展变革,连身袖的设计逐步由满足服装简单的美观性和宽松性向复杂综合的舒适性和运动功能性发展,其典型特征就是在腋下加入袖裆结构,使其在具有美观性的同时也具有舒适性与运动功能性。对于有袖裆的连身袖结构而言,袖裆是决定连身袖服装隐性袖窿大小的关键,也是关系到袖与身之间的协调、袖身共同承担的服装平服度、人体活动和穿着舒适等的重要因素,同时也对服装的款式、风格变化有着重要的影响。本文将从动态和静态两个角度来研究中性连身袖袖裆宽的变化对服装的外观造型和舒适性的影响,寻求能够同时满足服装静态美感和动态活动量的裆宽最佳取值范围。%Along with the development and reform of costume diversiifcation, the design of the kimono sleeve is gradually developing from meeting the apparel simple aesthetics and relaxation to complex comfortableness and sports functionality, and its typical characteristics is joining sleeve gusset-insert structure under the armpit, so as to achieve the aesthetics as well as comfortableness and sports functionality. For the kimono sleeve with gusset-insert , this structure is the key to recessive sleeve size, is not only closely related to the coordination between sleeve and body, smoothing degree made by sleeve and body, human body activities and wearing comfortableness, but also to the clothing design and style change. This paper studies the effects of width range of neutral kimono sleeve on the appearances and comfortableness of clothing from the dynamic and static perspectives, to ifnd out the optimized width range of satisfying the static aesthetics and dynamic activity of clothing.

  10. 轴心受压钢套管构件加固理论及应用%THE REINFORCEMENT THEORY AND APPLICATION OF AXIAL COMPRESSION STEEL SLEEVED MEMBER

    Institute of Scientific and Technical Information of China (English)

    王奇胜; 钱栋; 黄嵩; 胡波

    2013-01-01

    套管构件由内管及外管组成,外管能为内管提供侧向支撑,控制内管失稳,从而提高内管的受压承载力.套管构件是一种新型的钢压杆稳定加固形式,可应用于对受压钢构件失稳比较敏感的一类空间结构.本文首先利用典型的套管构件构造模型,阐述了轴心受压套管加固法的基本原理;然后以一网架工程为例,分析套管加固法对提高结构承载能力的效果.结果表明:套管构件能够有效改善网架结构的局部应力状况,解决了受压钢管的失稳问题,提高了网架结构的极限承载力.%Sleeved members consist of inner and sleeved tubes.The sleeved tube provides lateral support for the inner tube,and controls its instability,thereby enhancing its load-carrying capacity.As a new form for stability improving of compressive steel members,sleeved members can been applied to spatial structures,whose steel members are sensitive to buckling.This paper used a typical detail model of sleeved members to explain the basic principle of the reinforcement method of sleeved members; then taking a bridge of grid structure for example,analyzed this method for increasing the load-carrying capacity of the structure.The result shows that sleeved members can effectively improve the local stress conditions of grid structure,solve the problem of compression steel tubes prone to buckling,and enhance the ultimate load-carrying capacity of grid structure.

  11. 道岔用复合定位套优化改进%Optimization and Improvement of Composite Locating Sleeve Used for Turnouts

    Institute of Scientific and Technical Information of China (English)

    邹小魁; 沈艳杰

    2012-01-01

    Aiming at the fatigue failure of the existing composite locating sleeve under trains loads, in this paper, its structures are optimized and the calculation models of composite locating sleeve are established based on the theory of FEM( finite element method) and track dynamics. In the calculation model, the friction coefficient and the twisting moment of bolts in turnout sleepers are taken into account. The finite element method is used to study the stress of the composite locating sleeve. The results indicate that the composite locating sleeve optimized can meet the requirements of actual motion of trains, while the friction coefficient and twisting moment of bolts in turnout sleepers has little effects on the stress of the composite locating sleeve.%针对既有的复合定位套在列车荷栽作用下发生疲劳破损的情况,优化其结构,同时运用有限元法和轨道动力学理论建立复合定位套计算模型,考虑了摩擦系数、岔枕螺栓扭矩的影响因素,对模型的应力进行计算.结果表明:优化后的复合定位套可满足列车实际运行需求,而摩擦系数与岔枕螺栓扭矩对复合定位套的应力影响很小.

  12. Proximal gastrectomy and total gastrectomy controled clinical studies gastroesophageal junction cancer treatment%近端胃切除术和全胃切除术治疗食管胃结合部癌的临床对照研究

    Institute of Scientific and Technical Information of China (English)

    王治伟

    2014-01-01

    Objective: comparative analysis of total gastrectomy and proximal gastrectomy impact on the quality of life of cancer (AEG) in patients with esophageal gastric junction. Methods: AEG patients in our hospital in January 2012 -2013 December 30 routine total gastrectomy as a control group, and the other to select the same period in 30 patients with proximal gastrectomy routine as the observation group. Application-specific rating scale gastric (QLQ-STO22) evaluate the quality of life of patients. Results: The control group scored significantly higher than diet limited extent, the experimental group, the experimental group reflux, altered taste score was significantly higher (P <0.05). Conclusion: The proximal gastrectomy and total gastrectomy treatment AEG, wil merge different degrees of postoperative complications, the implementation of a lower total gastrectomy who taste and regurgitation scores, implementing proximal gastrectomy were restricted diet lighter degree.%目的:对比分析全胃切除术及近端胃切除术对食管胃结合部腺癌(AEG)患者生活质量的影响。方法选取我院2012年1月-2013年12月30例行全胃切除术的A E G患者作为对照组,另选取同期30例行近端胃切除术的患者作为观察组。应用胃癌特异性评价量表(QLQ-STO22)评价患者术后生活质量。结果对照组饮食受限程度得分明显高于实验组,实验组反流、味觉改变得分明显高于对照组(P<0.05)。结论采用近端胃切除术及全胃切除术治疗A E G,术后均会合并不同程度并发症,实施全胃切除术者味觉及反流得分更低,实施近端胃切除术者饮食受限程度更轻。

  13. Effects of glutamine-containing total parenteral nutrition on phagocytic activity and anabolic hormone response in rats undergoing gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Chen-Hsien Lee; Wan-Chun Chiu; Soul-Chin Chen; Chih-Hsiung Wu; Sung-Ling Yeh

    2005-01-01

    AIM: To investigate the effect of glutamine (Gln)-containing parenteral nutrition on phagocytic activity and to elucidate the possible roles of Gin in the secretion of anabolic hormones and nitrogen balance in rats undergoing a gastrectomy.METHODS: Rats with an internal jugular catheter were divided into 2 experimental groups and received total parenteral nutrition (TPN). The TPN solutions were isonitrogenous and identical in nutrient compositions except for differences in amino acid content. One group received conventional TPN (control), and in the other group, 25%of the total amino acid nitrogen was replaced with Gln.After receiving TPN for 3 d, one-third of the rats in each experimental group were sacrificed as the baseline group.The remaining rats underwent a partial gastrectomy and were killed 1 and 3 d, respectively, after surgery. Plasma,peritoneal lavage fluid (PLF), and urine samples were collected for further analysis.RESULTS: The Gin group had fewer nitrogen losses 1 and 2 d after surgery (d1, 16.6±242.5 vs -233.4±205.9 mg/d,d2, 31.8±238.8 vs-253.4±184.6 mg/d, P<0.05). There were no differences in plasma growth hormone (GH) and insulin-like growth factor-1 levels between the 2 groups before or after surgery. The phagocytic activity of peritoneal macrophages was higher in the Gin group than in the control group 1 d after surgery (4 1185±931 vs 323±201,P<0.05). There were no differences in the phagocytic activities of blood polymorphonuclear neutrophils between the 2 groups at the baseline or on the postoperative days.No significant differences in interleukin-1β or interleukin-6concentrations in PLF were observed between the 2 groups.However, tumor necrosis factor-α level in PLF was significantly lower in the Gin group than in the control group on postoperative d 3.CONCLUSION: TPN supplemented with Gin can improve the nitrogen balance, and enhance macrophage phagocytic activity at the site of injury. However, Gin supplementation has no effect

  14. Gastric wall thickening on spiral CT after subtotal gastrectomy for gastric cancer: comparision between recurrent caner and benign thickening

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chang Sook; Choi, Jong Cheol; Yoon, Sung Kuk; Kim, Jae Ik; Oh, Jong Young; Kang, Myung Jin; Lee, Ki Nam; Nam, Kyuung Jin [Donga Univ. College of Medicine, Pusan (Korea, Republic of)

    2000-12-01

    To determine the features revealed by two-phase spiral CT scanning useful for differential diagnosis between recurrent cancer and benign wall thickening in patients who have undergone subtotal gastrectomy for stomach cancer. We retrospectively reviewed 25 cases in which wall thickening of more than 1cm in the remnant stomach after subtotal gastrectomy was revealed by two-phase spiral CT scanning. All cases were confirmed: 11 were recurrent cancer, and in 14, benign wall thickening was demonstrated. We analyzed the CT findings including maximal thickness of the gastric wall, patterns of wall thickening, degree of contrast enhancement seen during the arterial and portal phases, and the presence of perigastric strands. Maximal wall thickness was classified as either more or less than 15mm, and as either focal or diffuse. We also determined whether lymphadenopathy was present. Mean maximal gastric wall thickness was 18.4mm in the recurrent cancer group ({sup g}roup A{sup )} and 12.6mm in the benign group ({sup g}roup B{sup )}. The gastric wall was thicker than 15mm in 10 of 11 group A cases and in 3 of 14 in group B; wall thickening was focal (n=3) or diffuse (n=8) in group A, and focal (n=13) or diffuse (n=1) in group B, while the enhancement patterns seen during the arterial and portal phase, respectively, were high/high (n=8), low/high (n=1) and low/low (n=2) in group A, and low/low (n=7), low/high (n=4), high/low (n=1) and high/high (n=2) in group B. Perigastric strands were observed in nine cases in group A, but in none in group B, while lymphadenopathy was combined with wall thickening in seven group A cases but in none of those in group B. In patients who have undergone subtotal gastrectomy for gastric cancer, two-phase spiral CT findings including maximal thickness of the gastric wall, patterns of wall thickening, degree of contrast enhancement seen during the arterial and portal phase, the presence of perigastric strands, and lymphadenopathy are useful for

  15. Effect of ivaradine on hyperpolarization activated cation current in canine pulmonary vein sleeve cardiomyocytes with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Yang Li; Yan Huang; Zongbin Li; Hao Wang; Jianguo Song; Yuqi Liu; Lei Gao; Shiwen Wang

    2008-01-01

    Objective To study the effect of ivabradine on hyperpolarization activated cation current in canine pulmonary vein(PY) sleeve cardiomyocytes with atrial fibrillation.Methods Dissociation of PVs yielded single cardiomyocytes from a Landengorff column without or with pacemaker activity from long-term rapidly atrial pacing (RAP) canines.If current was measured with the whole-cell patch-clamp technique.Results Compared with the control group,the rapidly atrial pacing canine PV cardiomyocytes had spontaneous diastolic depolarization and had larger If densities.Ivabradine (Iva,1 μM),a selective inhibitor of the If current,markedly reduced If currents in the RAP from -2.66±0.4 pA/pF to -1.58±0.1 pA/pF at the test potential of-120 mV (P<0.01,n=12).Inhibition effect of Iva of If current showed concentration-dependent range from 0.1 to 10.0μM,with IC50 of 2.2 μ M ( 1.8-2.9 μM,95% CL).Furthermore,V1/ of steady-state activated curve was shifted from -84.3±4.9 mV to -106.9±3.4 mV and k value of steady-state activated curve was changed from 12.1+2.6 mV to 9.9±3.4 mV by the application of.1.0 μM Iva ( P<0.01,n=12).Conclusions Our study revealed that Ivarbadine may significantly decrease If of rapidly atrial pacing pulmonary vein sleeve ceUs with atrial fibdllation.(J Geriatr Cardiol 2008;5:39-42)

  16. Band structure of semiconductors

    CERN Document Server

    Tsidilkovski, I M

    2013-01-01

    Band Structure of Semiconductors provides a review of the theoretical and experimental methods of investigating band structure and an analysis of the results of the developments in this field. The book presents the problems, methods, and applications in the study of band structure. Topics on the computational methods of band structure; band structures of important semiconducting materials; behavior of an electron in a perturbed periodic field; effective masses and g-factors for the most commonly encountered band structures; and the treatment of cyclotron resonance, Shubnikov-de Haas oscillatio

  17. [Chonic diarrhea and malabsorption due to common variable immunodeficiency, gastrectomy and giardiasis infection: a difficult nutritional management].

    Science.gov (United States)

    Domínguez-López, M E; González-molero, I; Ramírez-Plaza, C P; Soriguer, F; Olveira, G

    2011-01-01

    Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption.

  18. Impact of gender and body mass index on surgical outcomes following gastrectomy: an Asia-Pacific perspective

    Institute of Scientific and Technical Information of China (English)

    Seung Soo Lee; Seung Wan Ryu; In Ho Kim; Soo Sang Sohn

    2012-01-01

    Background Although surgeons may expect difficulties in performing gastrectomy on patients with high body mass index (BMI),it is not always the case,especially regarding patient gender.The aim of this study was to evaluate gender as a predictive factor of surgical outcomes related to obesity,as defined by the World Health Organization for the Asia-Pacific region.Methods Data of short-term surgical outcomes were obtained from 243 patients following open curative distal subtotal gastrectomy for gastric adenocarcinoma.Patients were classified into two groups by gender,and were further classified by BMI into group A (BMI ≥25 kg/m2) and group B (BMI <25 kg/m2).The operation time,extent of surgical bleeding,the number of resected lymph nodes,postoperative hospital stay,serum amylase levels,white blood cell count and postoperative complications were accessed for each group.Results Within male patients,the operation time tended to be longer in group A,albeit without statistical significance (P=0.075).However,the extent of surgical bleeding was significantly larger in group A (P=0.002).Within female patients,there were no such differences.When comparisons were made between male and female patients in group A,the operation time was significantly longer in male patients (P=0.019).The extent of bleeding tended to be larger in males,albeit without statistical significance (P=0.065).No such differences were seen when comparisons were made between male and female patients in group B.Conclusions Disparity in surgical outcomes between male and female patients does exist,particularly in patients with high BMI.Gender adjustment of BMI must be performed when predicting surgical outcomes.

  19. Robotic Total Gastrectomy With Intracorporeal Robot-Sewn Anastomosis: A Novel Approach Adopting the Double-Loop Reconstruction Method.

    Science.gov (United States)

    Parisi, Amilcare; Ricci, Francesco; Trastulli, Stefano; Cirocchi, Roberto; Gemini, Alessandro; Grassi, Veronica; Corsi, Alessia; Renzi, Claudio; De Santis, Francesco; Petrina, Adolfo; Pironi, Daniele; D'Andrea, Vito; Santoro, Alberto; Desiderio, Jacopo

    2015-12-01

    Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis.Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run.A new reconstructive approach, not yet described in literature, was recently adopted at our Center.Robotic total gastrectomy with D2 lymphadenectomy and a so-called "double-loop" reconstruction method with intracorporeal robot-sewn anastomosis (Parisi's technique) was performed in all reported cases.Preoperative, intraoperative, and postoperative data were collected and a technical note was documented.All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred.Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery.The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcomes.

  20. A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasion

    Institute of Scientific and Technical Information of China (English)

    Lin Jianxian; Huang Changming; Zheng Chaohui; Li Ping; Xie Jianwei; Wang Jiabin; Lu Jun

    2014-01-01

    Background Little is known about the feasibility and safety of laparoscopy-assisted total gastrectomy (LATG) with extended lymphadenectomy in patients with advanced gastric cancer (AGC).This study compared the technical feasibility,safety,and oncologic efficacy of LATG with open total gastrectomy (OTG) for AGC without serosa invasion.Methods From January 2009 to December 2011,235 patients underwent LATG and 153 patients underwent OTG for AGC without serosa invasion.Age,gender,and depth of invasion (pT2 and pT3) were matched by propensity scoring,and 116 patients (58 LATG and 58 OTG) were selected for analysis.Their clinicopathologic characteristics,postoperative outcomes,and survival were compared.Results There was no significant difference in clinicopathologic characteristics between the two propensity-matched groups.Median number of lymph nodes per patient was 29,and the mean number of retrieved lymph nodes was similar in the LATG and OTG groups (30.8±10.2 vs.29.0±8.3).Peri-operative characteristics,operation time,number of transfused units per patient,and time to resumption of activities were similar in the two groups; while blood loss,times to first flatus and resumption of soft diet,and post-operative stay were significantly lower in the LATG group (P <0.05,respectively).Rates of post-operative complications (12.1% vs.15.5%) and postoperative mortality (0% vs.1.7%),as well as cumulative survival rates,were similar.Conclusions LATG with D2 lymphadenectomy is a safe and feasible procedure for AGC patients without serosa invasion.ProsPective.multicenter,randomized trials are needed to confirm the efficacy of LATG in this patient population.

  1. Band parameters of phosphorene

    DEFF Research Database (Denmark)

    Lew Yan Voon, L. C.; Wang, J.; Zhang, Y.;

    2015-01-01

    Phosphorene is a two-dimensional nanomaterial with a direct band-gap at the Brillouin zone center. In this paper, we present a recently derived effective-mass theory of the band structure in the presence of strain and electric field, based upon group theory. Band parameters for this theory...

  2. Low Power Band to Band Tunnel Transistors

    Science.gov (United States)

    2010-12-15

    the E-field and tunneling at the source- pocket junction you form a parasitic NPN + transistor and the injection mechanism of carriers into the...hypothesis that the 1000 ° C, 5s anneal split lead to a very wide pocket and the accidental formation of a NPN + transistor , while the 1000 ° C, 1s anneal...Low Power Band to Band Tunnel Transistors Anupama Bowonder Electrical Engineering and Computer Sciences University of California at Berkeley

  3. Clinical Significance of the Prognostic Nutritional Index for Predicting Short- and Long-Term Surgical Outcomes After Gastrectomy: A Retrospective Analysis of 7781 Gastric Cancer Patients.

    Science.gov (United States)

    Lee, Jee Youn; Kim, Hyoung-Il; Kim, You-Na; Hong, Jung Hwa; Alshomimi, Saeed; An, Ji Yeong; Cheong, Jae-Ho; Hyung, Woo Jin; Noh, Sung Hoon; Kim, Choong-Bai

    2016-05-01

    To evaluate the predictive and prognostic significance of the prognostic nutritional index (PNI) in a large cohort of gastric cancer patients who underwent gastrectomy.Assessing a patient's immune and nutritional status, PNI has been reported as a predictive marker for surgical outcomes in various types of cancer.We retrospectively reviewed data from a prospectively maintained database of 7781 gastric cancer patients who underwent gastrectomy from January 2001 to December 2010 at a single center. From this data, we analyzed clinicopathologic characteristics, PNI, and short- and long-term surgical outcomes for each patient. We used the PNI value for the 10th percentile (46.70) of the study cohort as a cut-off for dividing patients into low and high PNI groups.Regarding short-term outcomes, multivariate analysis showed a low PNI (odds ratio [OR] = 1.505, 95% CI = 1.212-1.869, P cancer recurrence.

  4. The Effect of Thermal Double Distilled Water on Gastric Cancer Cell Line and Its Effect in Peritoneal Lavage During Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    CHENJunqing; XUHuimian; 等

    2002-01-01

    Objective:To evaluate the effect andindications of radical gastrectomy combined with peritoneal lavage with thermal double distilled water(DDW)or DDW plus chlorthexidine acetate.Methods:On the bases of the study on the killing effect of 43℃ DDW on human gastric cancer cell line MGC-803 and its inhibiting effect on ascitic tumor of SY86B morse,500 cases of gastric cancer who underwent radical gastectomy from January 1986 to December 1995 were divided into three groups:group A(n=198) subject to radical gastrectomy and peritoneal lavage for 10min with 4000ml DDW at 43℃ ;group B(n=89)subject to radical gastrectomy and peritoneal lavage for 4min with 4000ml DDW plus 0.6g chlorthexidine acetate,and grup C(n=213) subject to radical gastrectomy and peritoneal lavage for 4 min with 4000ml normal saline at room temperature as control.Results Human gastric cancer cells MGC-803 could be completely killed by treatment of either 43℃ DDW for 10min or DDW plus 0.015ml/L chlorhexidine acetate for 4 min.Clinical trials proved group A and group B(called lavage group as a whole)had almost the same curative effects.The 1-year survival rate and 3-year survival rate were similar in different stages among the groups.The 5-year survival rate was 63.8% in the lavage group and 51.2% in the control group respectively.Most of the cases with good effect were at the mid-stage (Ⅱand Ⅲ stage).Conclusion Radical gastrectom combined with peritoneal peritoneal lavage before closing the abdomen has satisfying effect on patients with gastric cancer at stage Ⅱ and stage ⅢA.

  5. The Effect of Endoscopic Resection on Short-Term Surgical Outcomes in Patients with Additional Laparoscopic Gastrectomy after Non-Curative Resection for Gastric Cancer

    Science.gov (United States)

    Lee, Eun-Gyeong; Eom, Bang-Wool; Yoon, Hong-Man; Kim, Yong-Il; Cho, Soo-Jeong; Lee, Jong-Yeul; Kim, Young-Woo

    2017-01-01

    Purpose Endoscopic submucosal dissection (ESD) in early gastric cancer causes an artificial gastric ulcer and local inflammation that has a negative intraprocedural impact on additional laparoscopic gastrectomy in patients with noncurative ESD. In this study, we analyzed the effect of ESD on short-term surgical outcomes and evaluated the risk factors. Materials and Methods From January 2003 to January 2013, 1,704 patients of the National Cancer Center underwent laparoscopic gastrectomy with lymph node dissection because of preoperative stage Ia or Ib gastric cancer. They were divided into 2 groups: (1) with preoperative ESD or (2) without preoperative ESD. Clinicopathologic factors and short-term surgical outcomes were retrospectively evaluated along with risk factors such as preoperative ESD. Results Several characteristics differed between patients who underwent ESD-surgery (n=199) or surgery alone (n=1,505). The mean interval from the ESD procedure to the operation was 43.03 days. Estimated blood loss, open conversion rate, mean operation time, and length of hospital stay were not different between the 2 groups. Postoperative complications occurred in 23 patients (11.56%) in the ESD-surgery group and in 189 patients (12.56%) in the surgery-only group, and 3 deaths occurred among patients with complications (1 patient [ESD-surgery group] vs. 2 patients [surgery-only group]; P=0.688). A history of ESD was not significantly associated with postoperative complications (P=0.688). Multivariate analysis showed that male sex (P=0.008) and laparoscopic total or proximal gastrectomy (P=0.000) were independently associated with postoperative complications. Conclusions ESD did not affect short-term surgical outcomes during and after an additional laparoscopic gastrectomy.

  6. 电切法袖套式包皮环切术200例临床分析%Electric cutting sleeve circumcision : clinical analysis of 200 cases

    Institute of Scientific and Technical Information of China (English)

    邹义华; 陈晓峰; 陈善群

    2012-01-01

    Objective:To evaluate the safety and effect of electric cutting sleeve circumcision for treatment of patients with redundant prepuce and phimosis. Method: Using electric cutting sleeve circumcision in 200 cases, the curative effect, complications and their prevention measures were analyzed. Result:The 200 cases of electric cutting sleeve circumcision show little bleeding, neat cutting, slight postoperative wound edema, little scar and satisfactory appearance of penis. Conclusion: With more satisfactory curative effect and fewer complications, Electric sleeve circumcision for treatment of patients with redundant prepuce and phimosis is worthy of clinical application.%目的:探讨电切法袖套式包皮环切术治疗包皮过长与包茎患者的安全性与疗效.方法:采用电切法袖套式包皮环切术治疗包皮过长与包茎患者200例,分析手术效果、并发症及其预防措施.结果:200例电切法袖套式包皮环切术出血少、切缘整齐,术后包皮水肿轻微,切口均一期愈合,癜痕少,阴茎外观满意.结论:电切法袖套式包皮环切术治疗包皮过长与包茎患者效果满意,并发症少,值得临床推广.

  7. Study on the change of metabolic indexes and digestive enzymes of patients with laparoscopic radical gastrectomy for gastric cancer during the perioperative period

    Institute of Scientific and Technical Information of China (English)

    Wen-Tao He; Jun Huang; Na Hu

    2016-01-01

    Objective:To investigate the influence degree of laparoscopic radical gastrectomy for gastric cancer on the related body indexes during the perioperative period, including metabolic indexes and digestive enzymes.Methods:A total of 70 patients with gastric cancer who received treatment during the time of January 2014 to November 2015 in our hospital were divided into two groups by the method of random number table, 35 patients with gastric cancer in control group were treated with open radical gastrectomy, 35 patients with gastric cancer in observation group were treated with laparoscopic radical operation, then the proteometabolism and digestive enzymes indexes at different time before and after the operations of two groups were detected and compared.Results:The differences of detection results of two groups before the operation were not obvious, while the related indexes of proteometabolism of observation group at first, third, seventh and fourteenth day after the operation were all higher than those of control group, and the related indexes of digestive enzymes were all better than those of control group, which were all obviously different.Conclusion: The influence of laparoscopic radical gastrectomy on the fluctuation of the metabolic indexes and digestive enzymes of patients during the perioperative period are relatively smaller, and the postoperative recovery of patients are relatively better.

  8. A comparative study of clinical effect on the Da Vinci surgical robot-assisted and laparoscopic-assisted distal subtotal gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:To evaluate the feasibility, safety and the clinical outcomes of the robotic distal gastrectomy for gastric cancer.Methods: We retrospectively analyzed the clinical and follow-up data of 113 cases underwent robotic distal gastrectomy from March 2010 to July 2013.Results:Compared with laparoscopic group, the robotic group had less intraoperative blood loss, more lymph nodes dissection (P<0.05). hTere was no signiifcant difference in the incidence of postoperative complications and neutrophil-lymphocyte ratio between the two groups. hTe follow-up data showed that the 1-, 2- and 3-year survival rates were 91.7%, 77.4% and 72.9% in robotic group while they were 91.2%, 76.2% and 70.4% in laparoscopic group ,and the difference was not significant. Conclusion:Robotic distal gastrectomy for gastric cancer is safe and effective, and it has less harm to the patients, with less intraoperative blood loss, more lymph nodes dissection and quicker postoperative recover than laparoscopic surgery, so it is worthy of popularization and application.

  9. Design and experiment on opening bag mechanism of sleeving machine for potted flowers%盆花包装机开袋机构设计与试验

    Institute of Scientific and Technical Information of China (English)

    辜松; 张青; 李恺; 杨艳丽; 刘凯

    2014-01-01

    With the improvement of people's living standard in China, the demand for flowers has been increasing annually, and further the sleeving requirement of potted flowers is also rising. The sleeving requirement is indicated to sleeve transparent packing bags for potted flowers. Packing bags are designed to beautify and protect potted flowers during transportation. In order to improve productivity, many large-scale enterprises producing potted flowers in Europe are using sleeving machine to sleeve potted flowers. But there are some problems due to the differences of bag type and producing process when foreign sleeving machine is used in China, along with the high price of foreign machines being 5-10 million Yuan. Now the automated production technology of greenhouse horticultural production in Netherland has reached the leading position in the world. The Netherlands has been developing automated sleeving machine for potted flowers. However, the sleeving machines have a problem, i.e., their opening bag mechanisms occasionally unsuccessfully make bag opening, because there is not a unit to keep bag from falling. According to the requirements of the domestic market and the instability problems of opening bag for small-size sleeving machines whose productivity are 1 200 pots/h, it is proposed to develop a hooking bag unit based on the above opening bag mechanism. The hooking bag unit can prevent the bag falling from the suckers during opening period, which will improve sleeving success ratio. The hooking bag unit is mainly constituted with push cylinder, hooking bag claw, link and synchronized shaft, etc. In this paper, based on the overall design of the opening bag mechanism, the main structural parameters of the sucker, moving unit to open bags and hooking bag unit were determined. First, according to the characteristics of packing bags, we chose the sucker type. Second, based on external diameter of the biggest pot and fixed hole spacing, the sucker spacing has been

  10. The use of a neoprene knee sleeve to compensate the deficit in knee joint position sense caused by muscle fatigue.

    Science.gov (United States)

    Van Tiggelen, D; Coorevits, P; Witvrouw, E

    2008-02-01

    The importance of good proprioceptive abilities is stressed in many rehabilitation protocols. In contrast, it has been shown that muscle fatigue has a negative influence on proprioception. The objective of this study was to evaluate the effects of a neoprene knee sleeve (NKS) on the joint position sense in a fatigued knee joint. Sixty-four healthy subjects underwent four successive assessments of the same active joint repositioning test (AJRT) in an open kinetic chain setting under different conditions. First, each subject performed the AJRT without brace. One knee was braced during the second assessment. Subjects wore the brace for 6 h and were submitted to a fatigue protocol, followed by the third assessment under the same conditions as the previous one. The fourth and last AJRT was performed immediately after the third one but both knees were non-braced. When the subjects wore an NKS, significant differences in repositioning error were demonstrated between both sides. On the braced side, no significant differences were observed between the baseline assessment and the third assessment. NKS compensate the deficit in joint position sense due to fatigue. The use of NKS could be justified as a preventive measure or treatment in subjects to enhance proprioception.

  11. Quantification of prosthetic outcomes: elastomeric gel liner with locking pin suspension versus polyethylene foam liner with neoprene sleeve suspension.

    Science.gov (United States)

    Coleman, Kim L; Boone, David A; Laing, Linda S; Mathews, David E; Smith, Douglas G

    2004-07-01

    For this randomized crossover trial, we compared two common transtibial socket suspension systems: the Alpha liner with distal locking pin and the Pe-Lite liner with neoprene suspension sleeve. Our original hypotheses asserted that increased ambulatory activity, wear time, comfort, and satisfaction would be found with the elastomeric suspension system. Thirteen subjects completed the study. Following 2.5-month accommodation to each condition, ambulatory activity was recorded (steps/minute for 2 weeks), and subjects completed three questionnaires specific to prosthesis use and pain: the Prosthesis Evaluation Questionnaire (PEQ), a Brief Pain Inventory (BPI) excerpt, and the Socket Comfort Score (SCS). Upon completion, subjects selected their favored system for continued use. Ten subjects preferred the Pe-Lite and three the Alpha. Subjects spent 82% more time wearing the Pe-Lite and took 83% more steps per day. Ambulatory intensity distribution did not differ between systems. No statistically significant differences were found in questionnaire results. Subject feedback for each system was both positive and negative.

  12. The Friction and Wear of Active Lubricants in theSleeve-ring Pair Lubricated by Presence of Magnetic Field

    Institute of Scientific and Technical Information of China (English)

    ZHOUQiang; LIJian-ping; LONGHong-sheng

    2004-01-01

    The effect of magnetic fteld on the tribological process of sleeve-ring pair lubricated by WRL lu-bricants was investigated by means of a NG-x wear tester and a PS5013 video microscope. The friction coefficient (f) and the wear weight(W) in lubricating test with WRL lubricant were decreased with the increase in the ,mag-netic field vertical to the rubbing surface, and an almost zero wear lubricating situation was gained in a magneticfield of 1000A/m. The captured wear micro particles on the rubbing surface were observed in the testing process,and the theoretical analysis of magnetic effects was completed. It is indicated that the magnetic field has not only a capturing action of wear micro particles on the worn surface, but also a inducing polarization0 of magnetic anisotropy of lubricant molecular. The actions promote the absorption of WRL lubricant into the wear swrface aswell as wear micro-particles, so that a good tribological effect is obtained when both magnetic field and WRL pr-esent.

  13. Short-term effects of supplementary feeding with enteral nutrition via jejunostomy catheter on post-gastrectomy gastric cancer patients

    Institute of Scientific and Technical Information of China (English)

    WU Quan; YU Jian-chun; KANG Wei-ming; MA Zhi-qiang

    2011-01-01

    Background Most gastric cancer patients who undergo gastrectomy develop malnutrition.It is,therefore,crucial to establish an effective means to provide nutrition for these patients.To perform home enteral nutrition (EN) to ensure adequate nutritional intake in gastric cancer patients,we placed a jejunostomy catheter during gastric surgery.Most patients showed improved nutritional status.Methods Twenty-nine inpatients at our hospital underwent radical gastrectomy and jejunostomy from December 2002 to December 2007 and were designated as the jejunostomy group,and 32 matched patients without a jejunostomy tube were designated as the tube-free group.The jejunostomy group was treated with EN from 72 hours to 3 months postoperatively.The tube-free group did not receive EN.Data including preoperative and postoperative body weight,body mass index (BMI),nutrition risk screening (NRS) score,Karnofsky performance score (KPS),and laboratory biochemical indicators were documented respectively and compared.Results Compared with preoperative week 1,both groups showed decreased body weight and BMI at 3 months postoperatively.The weight loss in the jejunostomy group ((7.1±3.3) kg) was significantly less than that in the tube-free group ((9.9±3.1) kg).Similarly,BMI decreased by (2.4+1.0) kg/m2 in the jejunostomy group,which was significantly less than in the tube-free group ((3.2±0.9) kg/m2).The number of patients with postoperative NRS ≥3 was decreased in the jejunostomy group,but was increased in the tube-free group,and this difference was significant.There were no significant differences between the two groups in total lymphocyte count,hemoglobin,albumin and prealbumin,and adverse drug effects.Conclusions Short-term (3 months) EN supplementation via jejunostomy tube can reduce the risk of malnutrition and weight loss,and improve tolerance of chemotherapy.Tube feeding is reliable for achieving these goals because it is not important whether or not the patients have appetites.

  14. ZEBRAFISH CHROMOSOME-BANDING

    NARCIS (Netherlands)

    PIJNACKER, LP; FERWERDA, MA

    1995-01-01

    Banding techniques were carried out on metaphase chromosomes of zebrafish (Danio rerio) embryos. The karyotypes with the longest chromosomes consist of 12 metacentrics, 26 submetacentrics, and 12 subtelocentrics (2n = 50). All centromeres are C-band positive. Eight chromosomes have a pericentric C-b

  15. Stretch Band Exercise Program

    Science.gov (United States)

    Skirka, Nicholas; Hume, Donald

    2007-01-01

    This article discusses how to use stretch bands for improving total body fitness and quality of life. A stretch band exercise program offers a versatile and inexpensive option to motivate participants to exercise. The authors suggest practical exercises that can be used in physical education to improve or maintain muscular strength and endurance,…

  16. Progressive Band Selection

    Science.gov (United States)

    Fisher, Kevin; Chang, Chein-I

    2009-01-01

    Progressive band selection (PBS) reduces spectral redundancy without significant loss of information, thereby reducing hyperspectral image data volume and processing time. Used onboard a spacecraft, it can also reduce image downlink time. PBS prioritizes an image's spectral bands according to priority scores that measure their significance to a specific application. Then it uses one of three methods to select an appropriate number of the most useful bands. Key challenges for PBS include selecting an appropriate criterion to generate band priority scores, and determining how many bands should be retained in the reduced image. The image's Virtual Dimensionality (VD), once computed, is a reasonable estimate of the latter. We describe the major design details of PBS and test PBS in a land classification experiment.

  17. Laparoscopically Assisted Proximal Gastrectomy with Esophagogastrostomy Using a Novel "Open-Door" Technique : LAPG with Novel Reconstruction.

    Science.gov (United States)

    Hosoda, Kei; Yamashita, Keishi; Moriya, Hiromitsu; Mieno, Hiroaki; Ema, Akira; Washio, Marie; Watanabe, Masahiko

    2016-12-26

    Laparoscopy-assisted proximal gastrectomy (LAPG) with esophagogastrostomy using a novel "open-door" technique was introduced recently, with the aim of preventing gastroesophageal reflux. However, quantitate assessment of gastroesophageal reflux after this surgery has not been performed till date. The aims of the current study were to investigate the safety and feasibility of this operation and to elucidate the postoperative reflux status. Twenty consecutive patients (18 men) with (y)cStage I gastric cancer in the upper third of the stomach who underwent LAPG at Kitasato University Hospital from May 2015 through September 2016 were retrospectively reviewed. We performed 24-h impedance-pH monitoring 3 months after surgery for the first eight patients and analyzed the postoperative reflux status. Median operation time was 333 min, while median anastomotic time was 81 min. None of the 20 patients experienced anastomotic leakage while two patients experienced anastomotic stricture requiring endoscopic balloon dilatation. No patient experienced heartburn without antacid drugs. During the 24-h impedance-pH monitoring, all but one patient had normal gastroesophageal acid reflux with the acid percent time of technique is a safe and feasible procedure for LAPG. The degree of gastroesophageal reflux was acceptable using this technique. Randomized controlled trials with long-term follow-ups are required to confirm that this technique would be superior to the others.

  18. Influence of an elevated nutrition risk score (NRS) on survival in patients following gastrectomy for gastric cancer.

    Science.gov (United States)

    Bachmann, J; Müller, T; Schröder, A; Riediger, C; Feith, M; Reim, D; Friess, H; Martignoni, M E

    2015-07-01

    In the last years, the impact of weight loss in patients with malignant tumors has come more and more into the focus of clinical research, as the occurrence of weight loss is often associated with a reduced survival. Weight loss can be a hint for metastases in patients suffering from malignant tumors; furthermore, these patients are usually not able to be treated with chemotherapy. The aim of the study was to show the influence of weight loss and an elevated nutrition risk score on survival following tumor resection in patients suffering from gastric cancer. In 99 patients in whom a gastrectomy due to gastric cancer was performed, the nutrition risk score was calculated and its influence on mortality, morbidity and survival was analyzed. Of the included patients, 45 % of the patients gave a history of weight loss; they had significantly more often a NRS ≥ 3. In UICC stage 1a/b, a NRS ≥ 3 was associated with a significantly reduced survival compared to patients with a NRS gastric cancer, the influence of a reduced NRS is negligible.

  19. Is gastrectomy-induced high turnover of bone with hyperosteoidosis and increase of mineralization a typical osteomalacia?

    Directory of Open Access Journals (Sweden)

    Takashi Ueyama

    Full Text Available Gastrectomy (GX is thought to result in osteomalacia due to deficiencies in Vitamin D and Ca. Using a GX rat model, we showed that GX induced high turnover of bone with hyperosteoidosis, prominent increase of mineralization and increased mRNA expression of both osteoclast-derived tartrate-resistant acid phosphatase 5b and osteocalcin. The increased 1, 25(OH2D3 level and unchanged PTH and calcitonin levels suggested that conventional bone and Ca metabolic pathways were not involved or changed in compensation. Thus, GX-induced bone pathology was different from a typical osteomalacia. Gene expression profiles through microarray analysis and data mining using Ingenuity Pathway Analysis indicated that 612 genes were up-regulated and 1,097 genes were down-regulated in the GX bone. These genes were related functionally to connective tissue development, skeletal and muscular system development and function, Ca signaling and the role of osteoblasts, osteoclasts and chondrocytes. Network analysis indicated 9 genes (Aldehyde dehydrogenase 1 family, member A1; Aquaporin 9; Interleukin 1 receptor accessory protein; Very low density lipoprotein receptor; Periostin, osteoblast specific factor; Aggrecan; Gremlin 1; Angiopoietin-like 4; Wingless-type MMTV integration site family, member 10B were hubs connected with tissue development and immunological diseases. These results suggest that chronic systemic inflammation might underlie the GX-induced pathological changes in bone.

  20. Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report

    Directory of Open Access Journals (Sweden)

    Kazuhito Yajima

    2012-01-01

    Full Text Available We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

  1. How to explant a diseased liver for living donor liver transplantation after previous gastrectomy with severe adhesion (with video).

    Science.gov (United States)

    Eguchi, Susumu; Soyama, Akihiko; Takatsuki, Mitsuhisa; Hidaka, Masaaki; Adachi, Tomohiko; Kitasato, Amane; Baimakhanov, Zhassulan; Kuroki, Tamotsu

    2014-08-01

    We performed living donor liver transplantation (LDLT) in a patient who had undergone distal gastrectomy for gastric ulcer disease with Billroth I reconstruction 30 years before the LDLT. The adhesion was very severe between remnant stomach and hepatic hilum as well as left liver lobe with shortening of hepatoduodenal structures. After dissection of the infrahepatic inferior vena cava, the Spiegel lobe was identified from the dorsal side. The Spiegel lobe was then penetrated with a right angle dissector so that a plastic tape could be placed around the whole adhesion, including important structures in the hepatoduodenal ligament. Next, the right hepatic vein was transected with a vascular stapler using Pringle's maneuver using the plastic tape to fasten the entire adhesional structure. Subsequently, the trunk of the middle and left hepatic vein was transected after clamping. The remaining short hepatic veins in the left side were divided completely from the cranial to the caudal direction to dissect Spiegel's lobe. Finally, the hepatoduodenal ligament was identified from the attached remnant stomach and the duodenum and a vascular clamp was placed on the entire hepatoduaodenal ligament. Finally, the diseased liver was explanted for graft implantation. Thus, retrograde explantation of the liver was effective in decreasing the risk of damaging vital elements in the hepatoduodenal ligament, the remnant stomach, and the duodenum.

  2. Billroth II with Braun Enteroenterostomy Is a Good Alternative Reconstruction to Roux-en-Y Gastrojejunostomy in Laparoscopic Distal Gastrectomy

    Science.gov (United States)

    Cui, Long-Hai; Shin, Ho-Jung; Byun, Cheulsu; Hur, Hoon; Han, Sang-Uk; Cho, Yong Kwan

    2017-01-01

    Background. Although Billroth II (BII) reconstruction is simpler and faster than Billroth I or Roux-en-Y (RY) reconstruction in patients undergoing totally laparoscopic distal gastrectomy (TLDG), BII reconstruction is associated with several complications, including more severe bile reflux. BII Braun anastomosis may be a better alternative to RY reconstruction. Methods. This retrospective study included 56 consecutive patients who underwent TLDG for gastric cancer, followed by BII Braun or RY reconstruction, between January 2013 and December 2015. Surgical outcomes, including length of operation, quantity of blood lost, and postoperative complications, were compared in the two groups. Results. Clinicopathological characteristics did not differ between the BII Braun and RY groups. Mean length of operation was significantly longer in the RY than the BII Braun group (157.3 min versus 134.6 min, p gastritis in the remnant stomach in the two groups. Conclusions. B-II Braun anastomosis is a good alternative to RY reconstruction, reducing length of operation and ileus after TLDG. PMID:28163716

  3. Percutaneous transhepatic duodenostomy for a gastrectomy case with CT guidance and real-time visualization by an ultrasound and endoscopy.

    Science.gov (United States)

    Moriwaki, Yoshihiro; Otani, Jun; Sawada, Yoshiyuki; Okuda, Junzo; Niwano, Toshiyuki; Ntta, Tachiko; Ohshima, Chiaki

    2015-09-01

    After gastrectomy, the remnant stomach, a small stomach behind the lateral segment of the liver, is thought to be a relative contraindication to receiving a percutaneous endoscopy-guided gastrostomy (PEG). We successfully performed a percutaneous duodenostomy in a case with remnant stomach. We used a transhepatic pull method with computed tomography (CT) guidance and real-time visualization by using ultrasound (US) and an endoscopy. The procedure was as follows: 1. Full stretching of the remnant stomach; 2. Insertion of a fine injection needle into the duodenal lumen through the lateral segment of the liver without an intrahepatic vascular and biliary injury using real-time visualization through US; 3. Confirmation of the location of the fine needle using abdominal CT, which showed the fine needle penetrating through the lateral segment and the duodenal lumen; 4. Insertion of the thick needle of the PEG kit just laterally of the fine needle; 5. Confirmation of the location of the thick needle using a repeated CT; 6. Endoscopic confirmation of the location of the two needles; 7. Changing the direction of the thick needle using guidance with endoscopy, inserting the thick needle into the duodenal lumen, and removing the fine needle; 8. Insertion of the guide wire through the thick needle; and 9. Placement of the PEG tube using the pull method. Using a real-time US scan, we detected the puncture of the anterior wall of the duodenum or stomach and avoided intrahepatic major vascular and biliary injuries.

  4. Iliotibial band friction syndrome.

    Science.gov (United States)

    Lavine, Ronald

    2010-07-20

    Published articles on iliotibial band friction syndrome have been reviewed. These articles cover the epidemiology, etiology, anatomy, pathology, prevention, and treatment of the condition. This article describes (1) the various etiological models that have been proposed to explain iliotibial band friction syndrome; (2) some of the imaging methods, research studies, and clinical experiences that support or call into question these various models; (3) commonly proposed treatment methods for iliotibial band friction syndrome; and (4) the rationale behind these methods and the clinical outcome studies that support their efficacy.

  5. Reinforcement of dented pipeline through composite sleeve repair systems subjected to fatigue by internal pressure; Reparos de dutos com amassamento atraves de luvas de materiais compositos submetidos a fadiga por pressao interna

    Energy Technology Data Exchange (ETDEWEB)

    Perrut, Valber Azevedo; Meniconi, Luiz Claudio de Marco [Centro de Pesquisas da Petrobras (CENPES). Gerencia de Tecnologia de Materiais, Equipamentos e Corrosao (Brazil)], e-mails: vperrut@petrobras.com.br, meniconi@petrobras.com.br; Souza Filho, Byron Goncalvez de [Transpetro (Brazil)], e-mail: byron.souza@petrobras.com.br

    2008-12-15

    Composite sleeve repair systems, now of widespread use in the market, were originally developed for the reinforcement of corroded pipelines. TRANSPETRO, the Brazilian pipeline operator, requested PETROBRAS/CENPES to address the behavior of sleeves when applied to dented pipelines. Simple verification experiments were carried out, in which both the dent filler material and the sleeve material were varied. Artificial dents with depths of 19% OD were imposed to 22 in. OD, 0.5 in. thick, API 5L X60 tubular specimens. Concrete and polymeric materials were tested for dent filler, whereas glass and carbon fiber composites, in two different thicknesses, were tried as the sleeve structural material. The main purpose of the repair sleeve in this case is to provide a repair procedure installed at low temperature and capable of reducing the stress range at the hot spot in the dent. The goal is to improve the fatigue resistance of the repaired pipeline. Low cycle fatigue tests were performed, both using non-repaired specimens (to serve as the basis for comparison) and specimens repaired using different schemes. The tests were fully instrumented to analyze strains in each specimen. After the fatigue tests, each specimen was pressurized until collapse, in order to quantify their ultimate strength. This paper reports the main results of the tests and the strain analysis for each repaired specimen, with the purpose of defining parameters which will serve to the design of future cases. (author)

  6. Diet after gastric banding

    Science.gov (United States)

    ... helps people who have a gastric band stay satisfied longer. This includes things like salad with grilled ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  7. HYBASE - HYperspectral BAnd SElection tool

    NARCIS (Netherlands)

    Schwering, P.B.W.; Bekman, H.H.P.T.; Seijen, H.H. van

    2008-01-01

    Band selection is essential in the design of multispectral sensor systems. This paper describes the TNO hyperspectral band selection tool HYBASE. It calculates the optimum band positions given the number of bands and the width of the spectral bands. HYBASE is used to calculate the minimum number of

  8. THE CLINICAL STUDY ON LAPAROSCOPIC RADICAL GASTRECTOMY FOR GASTRIC CANCER%腹腔镜胃癌根治手术的临床研究

    Institute of Scientific and Technical Information of China (English)

    李俊; 谭忆广; 周志涛; 毛常青; 吕培标; 钟国英; 王存川

    2011-01-01

    [目的]探讨腹腔镜胃癌根治手术的安全性、可行性及肿瘤根治性.[方法]选择2005年12月~2010年12月普外科行腹腔镜胃癌D2根治术35例为腹腔镜组,并选择同期开腹胃癌根治术40例为对照组,比较两组手术相关指标、肿瘤根治性指标及术后随访患者的生存率.[结果]腹腔镜组手术时间较对照组长,术中出血量较对照组少,切口长度较对照组短.差异具有统计学意义(均P<0.05);腹腔镜组术后排气时间、首次进流质时间及术后住院时间明显较对照组缩短(P<0.05),两组总并发症发生率比较差异无统计学意义(P>0.05);腹腔镜组肿瘤根治性指标淋巴结清扫数目、近远端切缘距离及1、3、5年生存率均与对照组差异无统计学意义(P>0.05).[结论]腹腔镜胃癌D2根治术是安全、可行的,能达到与开腹根治性全胃切除术相同的肿瘤根治性,且比开腹手术更具微创优势.%[Objective] To study the safety, feasibility and curative result of laparoscopic radical gastrectomy for gastric cancer. [Methods] 35 cases of laparoscopic radical gastrectomy for gastric cancer and 40 cases of open D2 radical gastrectomy were operated in our department from December 2005 to December 2010. The operative index, curative result index and survival rate in two groups were compared. [ Results] The operation time was longer, volume of bleeding was less, and the length of incision was shorter in laparoscopic radical gastrectomy group (P < 0.05) ; postoperative time of farting, the time of eating fluid and hospital stay were shorter in laparoscopic group compared to those in control group (P < 0.05). There was no significant difference in the rates of postoperative complications. The clear number of lymph node dissection , the proximal and distal margin from tumor and the 1-, 3-and 5-Y survival rate between the two groups were not different (P > 0.05). [ Conclusion] The laparoscopic D2 radical

  9. Total gastrectomy with or without abdominal drains. A prospective randomized trial Gastrectomía total con o sin drenajes abdominales

    Directory of Open Access Journals (Sweden)

    R. Álvarez Uslar

    2005-08-01

    Full Text Available The most common postoperative complications of total gastrectomy are esophagojejunal anastomotic leakage and subphrenic abscess. These complications are a cause of morbility and mortality, relaparotomy, and longer postoperative stay. The use of abdominal drains is useful for the early diagnosis and management of anastomotic leaks. The aim of this study was to analyze our experience with total gastrectomy for gastric cancer in patients with and without abdominal drains, and to evaluate the results regarding postoperative morbidity, postoperative hospital stay, postoperative days for oral intake, relapatorotomy and mortality. This prospective and randomized study examines the results in 60 consecutive patients (43 males and 17 females with gastric cancer who underwent total gastrectomy in the Regional Clinical Hospital of Concepción, Chile, between 2000 and 2003. Patients were divided into two groups: group I (without drains and group II (two drains. We found 31 patients in group I and 29 patients in group II. The mean length of postoperative stay was 12.9 days in group I and 18.8 days in group II (p = 0.0242, s.. Morbidity was 9.7% in group I and 37.9% in group II (p = 0.0242, s.. Re-explorations were more frequent in group II (24.1% versus group I (9.7% (p = 0.1239, n.s.. Postoperative days for oral intake were 9.4 in group I and 12.8 in group II (p = 0.0514, n.s. Mortality was 0% in group I and 3.4% in group II (p = 0.4833, n.s.. In our experience, morbidity and postoperative hospital stay were statistically higher in the group of patients with abdominal drains.

  10. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer: Analysis from a Large-Scale Cohort.

    Science.gov (United States)

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-03-01

    Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm²/m² for women and 40.8 cm²/m² for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I.

  11. Standards for pipelines repairs approval through composite sleeves materials; Criterios para aceitacao de reparos em dutos atraves de luvas de material composito

    Energy Technology Data Exchange (ETDEWEB)

    Bayer, Richard Foerster; Bifulco, Antonio C.; Vilani, Eduardo C. [Rust Engenharia Ltda., Diadema, SP (Brazil)

    2005-07-01

    The current paper presents the standards that define the test demanded by the technical specifications set for the evaluation of composite sleeves repairs for steel industrial ducts and pipelines, as well as their forecasted results. Practical comments are given about the adhesion, tensile strength, interlaminate shear resistance, impact, hardness, circumferential elasticity modulus, axial elasticity modulus, and the poison ratio rests, as well as the interpretation of those demands are also discussed. Explains the repair project and the procedure to be followed importance, and why qualified personnel are necessary to install it. The repair project and the procedure, as well as the repair construction effectiveness are verified by hydrostatics testes in tubular specimens. (author)

  12. Long-term changes in bone mass after partial gastrectomy in a well-defined population and its relation to tobacco and alcohol consumption

    DEFF Research Database (Denmark)

    Krogsgaard, M R; Frølich, A; Lund, B

    1995-01-01

    alcohol consumption or cumulative tobacco consumption and bone mineral content in each group. Gastrectomized women smoked much more than control women, and smoking may be a determinant factor for the bone loss, as it is in healthy persons. Operated patients had a lower intake of milk products. All...... patients were exposed to sunlight for more than 3 hours/week. It is suggested that osteopenia after gastrectomy might be caused by calcium depletion rather than lack of vitamin D. The consumption of tobacco but not of alcohol was connected to bone loss....

  13. Photonic band gap materials

    Science.gov (United States)

    Cassagne, D.

    Photonic band gap materials Photonic band gap materials are periodic dielectric structures that control the propagation of electromagnetic waves. We describe the plane wave method, which allows to calculate the band structures of photonic crystals. By symmetry analysis and a perturbative approach, we predict the appearance of the low energy photonic band gaps of hexagonal structures. We propose new two-dimensional structures called graphite and boron nitride. Using a transfer matrix method, we calculate the transmission of the graphite structure and we show the crucial role of the coupling with external modes. We study the appearance of allowed modes in the photonic band gap by the introduction of localized defects in the periodicity. Finally, we discuss the properties of opals formed by self-organized silica microspheres, which are very promising for the fabrication of three-dimensional photonic crystals. Les matériaux à bandes interdites photoniques sont des structures diélectriques périodiques qui contrôlent la propagation des ondes électromagnétiques. Nous décrivons la méthode des ondes planes qui permet de calculer les structures de bandes des cristaux photoniques. Par une analyse de la symétrie et une approche perturbative, nous précisons les conditions d'existence des bandes interdites de basse énergie. Nous proposons de nouvelles structures bidimensionnelles appelées graphite et nitrure de bore. Grâce à une méthode de matrices de transfert, nous calculons la transmission de la structure graphite et nous mettons en évidence le rôle fondamental du couplage avec les modes extérieurs. Nous étudions l'apparition de modes permis dans la bande interdite grâce à l'introduction de défauts dans la périodicité. Enfin, nous discutons les propriétés des opales constituées de micro-billes de silice auto-organisées, qui sont très prometteuses pour la fabrication de cristaux photoniques tridimensionnels.

  14. Effect of deep anesthesia on blood gas and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Zhen Wang; Xiao-Fan Li; Hui Wang; Zhi-Jun Mao; Tong Xue; Rui Yang

    2016-01-01

    Objective:To investigate the effects of deep anesthesia on blood gas and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer. Methods:A total of 84 gastric cancer patients in our hospital were randomly divided into observation group (42 cases) and control group (42 cases). Patients in observation group were treated by deep anesthesia, while the control group was treated with shallow anesthesia. The blood gas was observed and compared before and after CO2 pneumoperitoneum, and the immune function was observed and compared before anesthesia, after operation and 72 h post-operation. Results:The PaCO2 and pH level of patients in the two groups had no significant difference before pneumoperitoneum;Compared with before pneumoperitoneum, no obvious blood gas change was observed in the observation group, the difference had no statistically significant;Blood gas level of control group was significantly higher than that of before pneumoperitoneum , the difference was statistically significant, pH (7.26±0.07) was statistically decreased;After pneumoperitoneum, the level of PaCO2 and pH was significantly different in both groups , the difference was statistically significant. Indexes of the patients in the observation and control group of CD3+, CD4+, CD4+/CD8+, NK level had no significant difference before anesthesia, the difference was not statistically significant;The immunology index of CD3+, CD4+, CD4+/CD8+and NK cell levels of the postoperative patients in both groups were significantly lower than before anesthesia, and the differences were statistically significant, but each index in the observation group decreased significantly less than that of the control group, the difference was statistically significant;The immunological indexes can be restored to before anesthesia postoperative 72 h with two groups, and had no significant difference. Conclusion:The blood gas analysis index was stable and the immune function was suppressed in

  15. Prognostic Significance of MiR-34a Expression in Patients with Gastric Cancer after Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Wen-Tao Hui; Xiao-Bin Ma; Ying Zan; Xi-Jing Wang; Lei Dong

    2015-01-01

    Background:MiR-34a dysregulation has been implicated in tumorigenesis and progression of gastric cancer,but its role in prognosis of patients with gastric cancer remains unknown.The aim of this study was to investigate the expression and prognostic significance of miR-34a in gastric cancer patients after radical gastrectomy.Methods:Quantitative real-time polymerase chain reaction was performed to detect the expression of miR-34a in human gastric cancer cell lines and tissues in 76 patients with gastric adenocarcinoma from China.Results are assessed for association with clinical features and overall survival (OS) using Kaplan-Meier analysis.Prognostic values of miR-34a expression and clinical outcomes were evaluated by Cox regression analysis.A molecular prognostic stratification scheme incorporating miR-34a expression was determined using receiver operating characteristic analysis.Results:The results show that the expression level of miR-34a was decreased in human gastric cancer cell lines and tissues,and down-regulated expression of miR-34a was associated with Lauren classification (P =0.034).Decreased miR-34a expression in gastric cancer tissues was positively correlated with poor OS of gastric cancer patients (P =0.013).Further multivariate Cox regression analysis suggested that miR-34a expression was an independent prognostic indicator for gastric cancer (P=0.027).Applying the prognostic value of miR-34a expression to tumor node metastasis (TNM) stage system showed a better prognostic value in patients with gastric cancer than miR-34a expression (P =0.0435) or TNM stage (P =0.0249) alone.Conclusion:The results reinforce the critical role for the down-regulated miR-34a expression in gastric cancer and suggest that miR-34a could be a prognostic indicator for this disease.

  16. A modified delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: a safe and feasible technique.

    Directory of Open Access Journals (Sweden)

    Changming Huang

    Full Text Available The present study introduced a modified delta-shaped gastroduodenostomy (DSG technique and assessed the safety, feasibility and clinical results of this procedure in patients undergoing totally laparoscopic distal gastrectomy (TLDG for gastric cancer (GC.A total of 102 patients with distal GC undergoing TLDG with modified DSG between January 2013 and December 2013 were enrolled. A retrospective study was performed using a prospectively maintained comprehensive database to evaluate the results of the procedure. Univariate and multivariate analyses were performed to estimate the predictive factors for postoperative morbidity.The mean operation time was 150.6±30.2 min, the mean anastomosis time was 12.2±4.2 min, the mean blood loss was 48.2±33.2 ml, and the mean times to first flatus, fluid diet, soft diet and postoperative hospital stay were 3.8±1.3 days, 5.0±1.0 days, 7.4±2.1 days and 12.0±6.5 days, respectively. Two patients with minor anastomotic leakage after surgery were managed conservatively; no patient experienced any complications around the anastomosis, such as anastomotic stricture or anastomotic hemorrhage. Univariate analysis showed that age, gastric cancer with hemorrhage and cardiovascular disease combined were significant factors that affected postoperative morbidity (P<0.05. Multivariate analysis found that gastric cancer with hemorrhage was the independent risk factor for the postoperative morbidity (P = 0.042. At a median follow-up of 7 months, no patients had died or experienced recurrent or metastatic disease.The modified DSG was technically safe and feasible, with acceptable surgical outcomes, in patients undergoing TLDG for GC, and this procedure may be promising in these patients.

  17. Distribution Free Prediction Bands

    CERN Document Server

    Lei, Jing

    2012-01-01

    We study distribution free, nonparametric prediction bands with a special focus on their finite sample behavior. First we investigate and develop different notions of finite sample coverage guarantees. Then we give a new prediction band estimator by combining the idea of "conformal prediction" (Vovk et al. 2009) with nonparametric conditional density estimation. The proposed estimator, called COPS (Conformal Optimized Prediction Set), always has finite sample guarantee in a stronger sense than the original conformal prediction estimator. Under regularity conditions the estimator converges to an oracle band at a minimax optimal rate. A fast approximation algorithm and a data driven method for selecting the bandwidth are developed. The method is illustrated first in simulated data. Then, an application shows that the proposed method gives desirable prediction intervals in an automatic way, as compared to the classical linear regression modeling.

  18. Ultra wide band antennas

    CERN Document Server

    Begaud, Xavier

    2013-01-01

    Ultra Wide Band Technology (UWB) has reached a level of maturity that allows us to offer wireless links with either high or low data rates. These wireless links are frequently associated with a location capability for which ultimate accuracy varies with the inverse of the frequency bandwidth. Using time or frequency domain waveforms, they are currently the subject of international standards facilitating their commercial implementation. Drawing up a complete state of the art, Ultra Wide Band Antennas is aimed at students, engineers and researchers and presents a summary of internationally recog

  19. 镁合金轮椅小轮轴套焊接结构改进%Structure Improvement of Small Wheel Sleeve Welding on Mg Alloy Wheelchair

    Institute of Scientific and Technical Information of China (English)

    牛丽媛; 孙大仁; 林继兴; 华学兵

    2012-01-01

    The structure of small wheel sleeve welding on magnesium alloy wheelchair were investigated by altering small wheel sleeve welding position, and altering the location and direction of weld bead, which can contribute to the stress release, then the fatigue strength on the welding position was improved. The results show that there is a certain relationship between weld bead and fatigue strength, when the length of weld bead is more than 25 mm, the fatigue life can reach more than 210,000 times, which can meet wheelchair using requirements according to GB/T13800-2009.%研究了镁合金轮椅小轮轴套焊接部位的结构,改变了焊道的部位和方向,大大降低了焊接部位应力集中,有效地提高了焊接部位的疲劳强度.结果表明:焊道长度与疲劳性能有一定的关系,当焊道长度大于25mm时,其疲劳寿命可达21万次以上,根据GB/T 13800-2009标准测试满足轮椅的使用要求.

  20. A novel method to decrease electric field and SAR using an external high dielectric sleeve at 3 T head MRI: numerical and experimental results.

    Science.gov (United States)

    Park, Bu S; Rajan, Sunder S; Guag, Joshua W; Angelone, Leonardo M

    2015-04-01

    Materials with high dielectric constant (HDC) have been used in high field MRI to decrease specific absorption rate (SAR), increase magnetic field intensity, and increase signal-to-noise ratio. In previous studies, the HDC materials were placed inside the RF coil decreasing the space available. This study describes an alternative approach that considers an HDC-based sleeve placed outside the RF coil. The effects of an HDC on the electromagnetic (EM) field were studied using numerical simulations with a coil unloaded and loaded with a human head model. In addition, experimental EM measurements at 128 MHz were performed inside a custom-made head coil, fitted with a distilled water sleeve. The numerical simulations showed up to 40% decrease in maximum 10 g-avg. SAR on the surface of the head model with an HDC material of barium titanate. Experimental measurements also showed up to 20% decrease of maximum electric field using an HDC material of distilled water. The proposed method can be incorporated in the design of high field transmit RF coils.

  1. Solidifei d Structure Si mulation of the Cylinder Sleeves Castings in Vertical Centrifugal Casting%汽缸套立式离心铸造工艺仿真

    Institute of Scientific and Technical Information of China (English)

    凌有临; 夏乐春; 唐文献; 张宗政; 时学生

    2014-01-01

    运用ProCAST数值模拟软件对汽缸套立式离心铸造过程进行了数值模拟,确定了汽缸套铸件数值模拟的相关工艺参数:浇注速度2kg/s、浇注温度1300℃、铸型转速5000r/min。对汽缸套的立式离心铸造过程进行数值模拟分析,可以有效地预测缺陷,提高铸件质量,为生产提供了依据。%Taking ProCAST software to simulate the cylinder sleeves in complicated vertical centrifugal casting process, it determines the parameters for microstructure simulation , analyzes the cylinder liners in vertical cen-trifugal casting process , obtains the parameters required for the simulation of solidification structure for the cylin-der sleeve castings .It presents the related process simulation parameters such as casting rate:2kg/s, casting temperature:1300℃and mould speed:5000 r/min.The simulation analysis for vertical centrifugal casting cyl-inder liners process can effectively predict defects , improve the quality of castings and provide the basis for the production .

  2. Small gap anastomosis to repair peripheral nerve rupture using a nerve regeneration chamber constructed by scissoring and sleeve jointing autologous epineurium

    Institute of Scientific and Technical Information of China (English)

    Peiji Wang; Zhongliang Zhou; Qirong Dong

    2011-01-01

    A number of studies have shown how to eliminate the misorientated docking of the peripheral nerve bundle in the traditional epineurium or perineudum anastomosis, thus avoiding neuroma formation and axonal outgrowth from the coaptation sites, and seriously hindering neural function recovery. Based on the "peripheral nerve selective regeneration theory", this experiment was designed to investigate the feasibility and benefits of a new small gap anastomosis repairing peripheral nerve rupture, by scissoring and sleeve jointing an autologous epineurium. In the proximal stump of the nerve, a 1 mm-long epineurium was annularly separated and removed, while a 3 mm-long epineurium was longitudinally incised in the distal stump after the epineurium was dissociated from proximal to distal. The epineuria of the two stumps and the longitudinal incision were sutured, leaving a 2 mm gap between the two nerve stumps. Results show that the experimental rats quickly recovered autonomic activities, and there were minimal adhesions at the outer surface of the epineurial tube to the surrounding tissue. The morphologic changes to the sciatic nerve showed that connective tissue hyperplasia of the small gaps was significantly reduced, and nerve fibers were arranged orderly. No such changes were observed in the neurorrhaphy in situ group. Thus, the experiment confirmed that the new small gap anastomosis to repair peripheral nerve rupture by scissoring and sleeve jointing autologous epineurium is feasible, and that it is superior to epineurium neurorrhaphy in situ.

  3. WallFlex™ Duodenal Stent Placement in a Gastric Cancer Patient with Malignant Stenosis of a Roux-en-Y Gastrojejunostomy following Distal Gastrectomy

    Directory of Open Access Journals (Sweden)

    Tomoyuki Kakuta

    2012-10-01

    Full Text Available A 69-year-old Japanese woman with a history of distal gastrectomy with a Roux-en-Y reconstruction for advanced gastric cancer was admitted to our hospital complaining of severe dysphagia. On admission, the patient was only able to take liquids, and a firm, fist-sized tumor was palpable in her left upper abdomen. An endoscopic examination disclosed stenosis of the jejunal limb of the gastrojejunostomy. Abdominal computed tomography revealed that a recurrent tumor, 5.0 cm in diameter, was compressing the jejunal limb of the gastrojejunostomy. A knitted nitinol self-expandable metallic stent (WallFlex™ duodenal stent was placed endoscopically at the stenotic jejunum from the gastrojejunostomy. The time required for stenting and total endoscopic manipulation was 12 and 35 minutes, respectively. No stent-related complications were observed. The patient could resume oral ingestion 1 day after endoscopic stenting and was discharged on the fifth day after treatment. She survived for 201 days after stenting. She continued oral ingestion for 194 days and stayed at home for 165 days. The WallFlex duodenal stent allows safe endoscopic stenting, even in cases of malignant stenosis of a gastrojejunostomy following distal gastrectomy. This stenting device will extend the indications for endoscopic palliation of gastric cancer patients with gastric outlet stenosis.

  4. An investigation of the factors effecting high-risk individuals' decision-making about prophylactic total gastrectomy and surveillance for hereditary diffuse gastric cancer (HDGC).

    Science.gov (United States)

    Hallowell, Nina; Badger, Shirlene; Richardson, Sue; Caldas, Carlos; Hardwick, Richard H; Fitzgerald, Rebecca C; Lawton, Julia

    2016-10-01

    Hereditary diffuse gastric cancer has an early onset and poor prognosis, therefore, individuals who carry a pathogenic (CDH1) mutation in the E-cadherin gene (CDH1) are offered endoscopic surveillance and advised to undergo prophylactic total gastrectomy (PTG) in their early to mid-twenties. Patients not ready or fit to undergo gastrectomy, or in whom the genetic testing result is unknown or ambiguous, are offered surveillance. Little is known about the factors that influence decisions to undergo or decline PTG, making it difficult to provide optimal support for those facing these decisions. Qualitative interviews were carried out with 35 high-risk individuals from the Familial Gastric Cancer Study in the UK. Twenty-seven had previously undergone PTG and eight had been identified as carrying a pathogenic CDH1 mutation but had declined surgery at the time of interview. The interviews explored the experience of decision-making and factors influencing risk-management decisions. The data suggest that decisions to proceed with PTG are influenced by a number of potentially competing factors: objective risk confirmation by genetic testing and/or receiving a positive biopsy; perceived familial cancer burden and associated risk perceptions; perceptions of post-surgical life; an increasing inability to tolerate endoscopic procedures; a concern that surveillance could miss a cancer developing and individual's life stage. These findings have implications for advising this patient group.

  5. Colloquium: Topological band theory

    Science.gov (United States)

    Bansil, A.; Lin, Hsin; Das, Tanmoy

    2016-04-01

    The first-principles band theory paradigm has been a key player not only in the process of discovering new classes of topologically interesting materials, but also for identifying salient characteristics of topological states, enabling direct and sharpened confrontation between theory and experiment. This review begins by discussing underpinnings of the topological band theory, which involve a layer of analysis and interpretation for assessing topological properties of band structures beyond the standard band theory construct. Methods for evaluating topological invariants are delineated, including crystals without inversion symmetry and interacting systems. The extent to which theoretically predicted properties and protections of topological states have been verified experimentally is discussed, including work on topological crystalline insulators, disorder and interaction driven topological insulators (TIs), topological superconductors, Weyl semimetal phases, and topological phase transitions. Successful strategies for new materials discovery process are outlined. A comprehensive survey of currently predicted 2D and 3D topological materials is provided. This includes binary, ternary, and quaternary compounds, transition metal and f -electron materials, Weyl and 3D Dirac semimetals, complex oxides, organometallics, skutterudites, and antiperovskites. Also included is the emerging area of 2D atomically thin films beyond graphene of various elements and their alloys, functional thin films, multilayer systems, and ultrathin films of 3D TIs, all of which hold exciting promise of wide-ranging applications. This Colloquium concludes by giving a perspective on research directions where further work will broadly benefit the topological materials field.

  6. Exceptionally large banded spherulites

    Science.gov (United States)

    Lagasse, R. R.

    1994-07-01

    This article concerns the crystallization of maleic anhydride from a blend containing 2 wt% of poly(acrylonitrile). High speed photography and temperature measurements during the crystallization as well as X-ray diffraction from the blend after crystallization are consistent with a banded spherulitic morphology.

  7. DUAL BAND MONOPOLE ANTENNA DESIGN

    Directory of Open Access Journals (Sweden)

    P. Jithu

    2013-06-01

    Full Text Available The WLAN and Bluetooth applications become popular in mobile devices, integrating GSM and ISM bands operation in one compact antenna, can reduce the size of mobile devices. Recently, lot many investigations are carried out in designing a dual band antennas with operating frequencies in GSM band and in ISM band for mobile devices. Printed monopoles are under this investigation. In this paper, dual-band printed monopoles are presented to operate at GSM band i.e. 900 MHz and ISM band i.e. 2.4 GHz. We intend to observe the antenna characteristics on the network analyzer and verify the theoretical results with the practical ones.

  8. 胃癌切除术后胃肠道瘘的治疗%Gastrointestinal leakage after gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    唐云; 李荣; 陈凛; 卫勃; 武现生

    2010-01-01

    Objective To summarize the treatment experiences in gastrointestinal leaJcage atter gastrectomy for gastric cancer. Mehods From January 1997 to December 2006 the clinical data of 37 cases of gastrointestinal leakage including anastomotic leakage in 19 cases and duodenal stump leakage in 18 after gastrectomy for gastric cancer in People's Liberation Army General Hospital were analyzed retrospectively. Results All of the Cases were treated with abdominal drainage,continuous gastrointinal decomnression and parenteral nutrition combined with enteral nutrition.There were 32 cases receiving glutamine enrichment nutrition support,31 ases used somatostatin,13 cases received supplemented recombinarlt human growth hormone.Fistula healed in 21~30 d in 9 cases after gastrectomy,in the other 24 cases fistula healed in 30-60 d,while it healed in 60~81 d in the remaining 2 cases.Two died of leakage associated complications after gastrectomy for gastric cancer including anastomotlc leakage follwing esophagojejunostomy complicated by severe thoracic and lung infection in one and duodenal stump leakage complicated by severe abdominal cavity sepsis and hemorrhage in the other. Conclusion Patent and effective abdominal cavity drainage,continuous gastrointestinal decompression,parenteral nutrition combined with enteral nutrition,glutarnine,somatostafin and recombinant human growth hormone are the'mportant factors for the healing of gastrointestinal leakage after gastrectomy tor gastric cancer.%目的 总结胃癌切除术后胃肠道瘘的治疗经验,以提高对胃癌切除术后胃肠道瘘的治疗水平.方法 对1997年1月至2006年12月在北京解放军总医院治疗的胃癌切除术后19例吻合El瘘和18例十二指肠残端瘘共37例胃肠道瘘患者进行回顾性分析.结果 本组37例均加强了瘘口附近的腹腔引流,采用了持续胃肠减压,先给予肠外营养支持、然后从肠外营养支持逐步过渡到肠内营养支持的治疗手段.32

  9. Diffuse interstellar absorption bands

    Institute of Scientific and Technical Information of China (English)

    XIANG FuYuan; LIANG ShunLin; LI AiGen

    2009-01-01

    The diffuse interstellar bands (DIBs) are a large number of absorption bands that are superposed on the interstellar extinction curve and are of interstellar origin. Since the discovery of the first two DIBs in the 1920s, the exact nature of DIBs still remains unclear. This article reviews the history of the detec-tions of DIBs in the Milky Way and external galaxies, the major observational characteristics of DIBs, the correlations or anti-correlations among DIBs or between DIBs and other interstellar features (e.g. the prominent 2175 Angstrom extinction bump and the far-ultraviolet extinction rise), and the proposed candidate carriers. Whether they are also present in circumstellar environments is also discussed.

  10. Diffuse interstellar absorption bands

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The diffuse interstellar bands(DIBs) are a large number of absorption bands that are superposed on the interstellar extinction curve and are of interstellar origin. Since the discovery of the first two DIBs in the 1920s,the exact nature of DIBs still remains unclear. This article reviews the history of the detections of DIBs in the Milky Way and external galaxies,the major observational characteristics of DIBs,the correlations or anti-correlations among DIBs or between DIBs and other interstellar features(e.g. the prominent 2175 Angstrom extinction bump and the far-ultraviolet extinction rise),and the proposed candidate carriers. Whether they are also present in circumstellar environments is also discussed.

  11. 正挤横轧式农用车后桥半轴套管的研究开发%Study and Development of the Rear Axle Shaft Sleeves of Farm Transport Vehicle by Forward Extrusion and Cross Rolling

    Institute of Scientific and Technical Information of China (English)

    韩英淳; 王学明; 唐志强

    2001-01-01

    在成功地开发轻型车正挤与横轧式后桥半轴套管的基础上,自主开发了1608型、2310型及2815型农用运输车的正挤与横轧式后桥半轴套管,并实现系列化规模生产,获得了显著的社会经济效益。%On the basis of the development of the rear axle shaft sleeve of the light truck CA1040 by forward extrusion and cross rolling, to adapt to the rapid growth of farm transport vehicle, the rear axle shaft sleeve of farm transport vehicle 1608,2310,2815 have been developed successively and manufactured on a big scale. In accordance with the characteristic in geometrical shape of the rear axle shaft sleeve, we change it into a detached structure based on the equal strength theory. Since the detached sleeve bodies have a small difference in diameter, they can be formed with technology of the forward extrusion and cross rolling.

  12. Micromechanics of shear banding

    Energy Technology Data Exchange (ETDEWEB)

    Gilman, J.J.

    1992-08-01

    Shear-banding is one of many instabilities observed during the plastic flow of solids. It is a consequence of the dislocation mechanism which makes plastic flow fundamentally inhomogeneous, and is exacerbated by local adiabatic heating. Dislocation lines tend to be clustered on sets of neighboring glide planes because they are heterogeneously generated; especially through the Koehler multiple-cross-glide mechanism. Factors that influence their mobilities also play a role. Strain-hardening decreases the mobilities within shear bands thereby tending to spread (delocalize) them. Strain-softening has the inverse effect. This paper reviews the micro-mechanisms of these phenomena. It will be shown that heat production is also a consequence of the heterogeneous nature of the microscopic flow, and that dislocation dipoles play an important role. They are often not directly observable, but their presence may be inferred from changes in thermal conductivity. It is argued that after deformation at low temperatures dipoles are distributed a la Pareto so there are many more small than large ones. Instability at upper yield point, the shapes of shear-band fronts, and mechanism of heat generation are also considered. It is shown that strain-rate acceleration plays a more important role than strain-rate itself in adiabatic instability.

  13. DEFINITION OF DENSITY OF THE THERMAL STATIONARY STREAMS ON A SURFACES OF A SLEEVE OF CYLINDER COMBUSTION ENGINE BY A METHOD OF OPTIMUM FILTRATION KALMANA

    Directory of Open Access Journals (Sweden)

    ZARENBIN V. G.

    2016-01-01

    Full Text Available Problem statement. At research warmly intensity and thermal weariness of internal combustion engines (ICE the knowledge and the analysis of local temperatures and thermal streams in the basic details forming the chamber of combustion is defining. Theoretically the problem consists in the decision of the equation of heat conductivity at the set features of course of thermal processes on border of bodies. Thus there is a problem of accuracy of the decision since it depends on accuracy of the task of real boundary conditions which can be received only by means of physical experiment and corresponding metrological maintenance. Unlike temperature the thermal stream cannot be measured directly, therefore it define on a difference of temperatures (thermal gradient a method or a calorimetric method. Definition of density of streams with the help as named gauges of a thermal stream when the measured temperatures are used at the decision of a return problem of heat conductivity for chosen thermometric an element is most extended. In this case, except the requirement of one-dimensionality of distribution of temperatures, linearity and the minimum distortion of temperature fields of thermal system, there are considerable difficulties of calculation derivative of the measured temperature. To perspective it is possible to carry methods of researches which it is accepted to name cybernetic diagnostics or identification of systems. Their essence consists that the deformed information on object is compared to its mathematical model and then are defined its condition, parameters or entrance influences by minimization of square-law function are nonviscous. In work definition of density of thermal stationary streams on surfaces of a sleeve of cylinder ICE by a method of optimum filtration Kalmana and also an estimation of their reliability and accuracy is made. Possibility of application of filtration Kalmana is shown at experimental researches in ICE. The purpose

  14. Current status of bariatric surgery in Japan and effectiveness in obesity and diabetes

    OpenAIRE

    2013-01-01

    The rate of obesity in Japan, defined as having a body mass index (BMI) of 25 kg/m2 or greater, is reportedly at 24 %, a lower level of severe obesity than in the EU and US. However, the incidence of obesity-related health problems is reportedly higher among Asians. Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery in Japan and accounted for 54 % of such surgeries in 2011; procedures such as laparoscopic adjustable gastric banding and laparoscopic Roux-e...

  15. Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass for the Management of morbid obesity: a Meta-analysis of randomized controlled trials%腹腔镜胃袖套状切除术与Roux-en-Y 胃肠短路术治疗肥胖的随机对照试验研究Meta 分析

    Institute of Scientific and Technical Information of China (English)

    杜弢; 王国强; 李小维; 李万根

    2012-01-01

    系统评价腹腔镜胃袖套状切除术(LSG)与腹腔镜Roux-en-Y 胃肠短路术(LRYGB)两种术式对肥胖患者的疗效及其临床应用价值.通过Pubmed、Embase、Springerlink、万方和CNKI 数据库检索LSG 与LRYGB 两种术式治疗肥胖的随机对照研究文献,文献检索时间截止至2012 年4 月.共纳入6 篇随机对照试验研究文献,Meta 分析的结果显示两术式对术后患者体重指数、额外体重丢失、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、HbA1c、空腹血糖、胰岛素和HOMAIR的影响均无统计学差异(P>0.05).LSG 与LRYGB 作为外科治疗肥胖的两种常用术式,两者在术后体重、血糖、血脂的控制效果相当,提示LSG 可作为外科治疗肥胖的主要术式之一.

  16. Distal Gastrectomy of Gastric and Duodenal Ulcer%胃十二指肠溃疡远端胃部分切除术

    Institute of Scientific and Technical Information of China (English)

    陈中成

    2014-01-01

    目的:探讨胃十二指肠溃疡患者行胃部分切除术治疗效果。方法对30例胃十二指肠溃疡患者行远端胃部分切除术治疗资料进行分析。结果30例十二指肠患者Bil roth I式10例,Bil roth II式20例,重建手术时间40~90 min。吻合口溃疡2例,反流性胃炎1例,残胃炎4例,经治疗所有患者均痊愈出院。结论胃十二指肠溃疡常用的手术方式是远端胃大部切除术,Bil roth I式胃十二指肠吻合或Bil roth I式胃空肠吻合重建,具体视切除的范围和十二指肠残端的情况而定。%Objective The distal gastrectomy effect on patients with gastric and duodenal ulcer to be investigated. Methods Analyze the treatment data selected from 30 patients with gastric and duodenal ulcer who are operated with distal gastrectomy. Results Among 30 patients, 10 patients with duodenal ulcer are categorized into Bil roth I Type, and the other 20 patients are categorized into Bil roth II Type, the operation reconstruction time is from 40 minutes to 90 minutes. And there are two cases of anastomotic ulcer, one case of reflux gastric and 4 cases of residual gastritis. Al of patients are cured and discharged from hospital after treatment. Conclusion The distal gastrectomy, gastric and duodenal anastomosis of Bil roth I Type or gastrojejunostomy reconstruction of Bil roth II Type is the common surgical method to cure gastric and duodenal ulcer, the choice of the surgical method is determined by resection scope and duodenal stump condition.

  17. 胃癌根治术后胰瘘5例临床分析%Pancreatic fistula after radical gastrectomy for gastric carcinoma: report of 5 cases

    Institute of Scientific and Technical Information of China (English)

    孙益红; 汪学非; 沈振斌; 王单松; 陈伟东; 王聪; 秦净; 秦新裕

    2008-01-01

    目的 探讨胃癌根治术后胰瘘的病因、临床表现、诊断及治疗方法.方法 对5例胃癌根治术后胰瘘患者的临床资料进行回顾性分析.结果 5例患者出现胰瘘可疑症状的时间分别为术后第2、3、4、6、8天.5例均出现心动过速(HR>120次/min)、持续发热(T>38.5 oC)和血白细胞升高(WBC计数>15×109/L).影像学检查胸片提示胸腔积液3例,3例CT检查提示腹腔积液,2例同时伴有胰腺肿胀.5例腹腔引流液淀粉酶均>10 000 U/L.5例患者中2例经保守治疗3周后治愈,另3例经再次手术引流后1~4个月治愈.结论 术中胰腺损伤是导致胃癌根治术后胰瘘的主要原因;早期诊断,充分的引流是保证术后胰瘘治愈的关键.%Objective To analyze clinical characteristics, etiology, diagnosis and treatment of pancreatic fistula following radical gastrectomy for gastric carcinoma. Methods Clinical data of 5 patients with pancreatic fistula undergoing radical gastrectomy were analyzed retrospectively. Results Suspected symptoms of pancreatic fistula occurred in the 2nd, 3rd, 4th, 6th and 8th days after the first operation respectively. All patients showed tachyarrhythmia, persistent hyperpyrexia and increased count of leukocyte, 2 had abdominal distention, 2 had abdominal pain, and 2 had adequate abdominal drainage with a turbid appearance as well as increased level of amylase. Imaging examination showed that pleural effusion appeared in 3 patients, seroperitoneum in 3, and pancreas swelling in 2. Three of 5 patients received re-operations and the other 2 were treated conservatively. All of these patients recovered after thorough drainage. Conclusion The onset of pancreatic fistula following radical gastrectomy is iniatiated by surgical trauma of the pancreas. Reasonable range of lymphadenectomy plays a key role to avoid postoperative pancreatic fistula. Sufficient drainage of the abdominal cavity ensures a full recovery from pancreatic complications.

  18. Long-term effects of gastrectomy in patients with spirometry-defined COPD and patients at risk of COPD: a case-control study

    Directory of Open Access Journals (Sweden)

    Saito H

    2015-10-01

    Full Text Available Hitoshi Saito,1,2 Koichiro Nomura,1,2,† Shinji Abe,1,2 Takashi Motegi,2,3 Takeo Ishii,2,3 Kumiko Hattori,2,3 Yuji Kusunoki,2,3 Akihiko Gemma,2 Kozui Kida2,3 1Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, 2Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan, 3Respiratory Care Clinic, Nippon Medical School †Koichiro Nomura passed away on July 30, 2014 Objective: Comorbidities are characteristic of COPD. However, little is known about the secondary manifestations of COPD in the gastrointestinal tract. Therefore, we aimed to explore the long-term effects of gastrectomy in patients with spirometry-defined COPD or those at risk of COPD.Participants: Subjects included 87 patients either with COPD or at risk of COPD (symptomatic who underwent gastrectomy between December 2003 and October 2013 (group A, and 174 patients either with COPD or at risk of COPD, matched by age (±5 years, sex, and forced expiratory volume in 1 second (FEV1 as percentage of predicted (FEV1% predicted (±5% (group B.Methods: All patients underwent routine blood chemistry and pulmonary function tests, arterial blood gas analysis, 6-minute walk test (6MWT, high-resolution chest computed tomography scans, and nutritional assessments.Results: The mean duration postgastrectomy was 18.3±15.4 years. The mean FEV1 and FEV1% predicted were 2.07±0.76 L and 74.6±24.5%, respectively. Univariate analysis indicated that group A patients had significantly lower body mass index, fat-free mass index, and serum hemoglobin and albumin concentration (all P=0.00, and walked a significantly shorter distance in the 6MWT (P<0.05. Multivariate linear regression analysis for the distance in the 6MWT indicated that increased residual volume (RV to total lung capacity (TLC as percentage of predicted (%RV/TLC alone was an independent and significant predictor of reduced distances in the 6MWT.Conclusion: We concluded

  19. A schwannoma of the S1 dural sleeve was resected while the intact nerve fibers were preserved using a microscope. Report of a case with early MRI findings.

    Science.gov (United States)

    Kobayashi, S; Uchida, K; Kokubo, Y; Yayama, T; Nakajima, H; Inukai, T; Nomura, E; Baba, H

    2007-04-01

    In this report, we describe a small schwannoma of the dural sleeve and mention that it is often difficult to differentiate this tumor from lumbar disc herniation, especially a sequestered hernia, or a discal cyst. Gadolinium-enhanced MR images were a useful preoperative examination modality for differentiating this lesion from other diseases. Microscopically, the intradural tumor was successfully removed. The dura mater of the S1 nerve root was opened microsurgically, allowing the nerve fibers involved in the tumor to be identified. The involved fibers were cut around the tumor, and the lesion was resected while the intact nerve fibers were preserved. Based on histological examination of the resected specimen, the tumor was diagnosed as a schwannoma with multilocular cystic degeneration. Microsurgery allowed the tumor to be removed with minimal impairment from cutting of nerve fibers in the nerve root.

  20. Combined Double Sleeve Lobectomy and Superior Vena Cava Resection for Non-small Cell Lung Cancer with Persistent Left Superior Vena Cava

    Directory of Open Access Journals (Sweden)

    Daxing ZHU

    2015-11-01

    Full Text Available A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department. Bronchoscopy displayed complete obstruction of right upper lobe bronchus and infiltration of the bronchus intermedius with tumor. Chest contrast computed tomography revealed the tumor invaded right pulmonary artery, superior vena cava, and the persistant left superior vena cava flowed into the coronary sinus. The tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava (SVC utilizing ringed polytetrafluoroethylene graft. To the best of our knowledge, this was the first report of complete resection of locally advanced lung cancer involving superior vena cava, right pulmonary artery trunk and main bronchus with persistant left superior vena cava.

  1. Combined Double Sleeve Lobectomy and Superior Vena Cava Resection for Non-small Cell Lung Cancer with Persistent Left Superior Vena Cava

    Institute of Scientific and Technical Information of China (English)

    Daxing ZHU; Xiaoming QIU; Qinghua ZHOU

    2015-01-01

    A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department. Bronchoscopy displayed complete obstruction of right upper lobe bronchus and inifltration of the bronchus intermedius with tumor. Chest contrast computed tomography revealed the tumor invaded right pulmonary artery, superior vena cava, and the persistant letf superior vena cava lfowed into the coronary sinus. hTe tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava (SVC) utilizing ringed polytetralfuoroethylene gratf. To the best of our knowledge, this was the ifrst report of complete resection of locally advanced lung cancer involving superior vena cava, right pulmonary artery trunk and main bronchus with persistant letf superior vena cava.

  2. Duodeno-enteral omega switches – more physiological techniques in metabolic surgery

    Science.gov (United States)

    Karcz, W. Konrad; Kuesters, Simon; Marjanovic, Goran

    2013-01-01

    Introduction In bariatric surgery, still new surgical techniques are developed. On the one hand, the Roux-en-Y gastric bypass (RYGB) is one of the most common procedures used. However, many patients experience dumping syndrome or pain due to bile reflux. On the other hand, revisions after gastric banding are frequent and may be technically challenging. Aim To create a new bariatric procedure counterbalancing the drawbacks of conventional RYGB, also suitable as a redo option after gastric banding. Material and methods To diminish the complication rate and pathophysiological disadvantages in reoperations after gastric banding, we primarily combined a gastric plication (GP) with a single anastomosis duodeno-ileal omega switch (DIOS), bypassing 2/3 of the total bowel length. Further on, in patients with lower body mass index we combined a GP or LSG and laparoscopic sleeve gastrectomy with a duodeno-jejunal omega switch (DJOS), performing an end-to side anastomosis after 1/3 of the total bowel length. Results The DIOS and DJOS techniques restrict food intake and bypass the duodenum and part (DJOS) or the whole (DIOS) jejunum. Restriction is achieved either through gastric plicature or conventional sleeve gastrectomy. Conclusions Similar bariatric and metabolic effects to proximal RYGB are expected in the case of DJOS, or to a conventional duodenal switch when performing a DIOS procedure. Performing a gastric plicature will reduce the risk of gastric leak when revising patients after failed gastric banding. PMID:24501596

  3. Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres:multiple ampliifcation of axonal regeneration

    Institute of Scientific and Technical Information of China (English)

    Yu-hui Kou; Pei-xun Zhang; Yan-hua Wang; Bo Chen; Na Han; Feng Xue; Hong-bo Zhang; Xiao-feng Yin; Bao-guo Jiang

    2015-01-01

    Multiple-bud regeneration,i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve ifber regeneration. Our previous studies have veriifed the limit and validity of multiple ampli-ifcation of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple ampli-ifcation of myelinated nerve ifber regeneration in the primate peripheral nerve. Rhesus monkey models of distal ulnar nerve defects were established and repaired using muscular branches of the right forearm pronator teres. Proximal muscular branches of the pronator teres were su-tured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-ifnger lfexion and mild wrist lfexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological examination showed that motor nerve conduction veloc-ity reached 22.63 ± 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ± 652 in the branches of pronator teres of donor, and 2,661 ± 843 in the repaired ulnar nerve. The rate of multiple ampliifcation of regenerating myelinated nerve ifbers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve ifbers, and functions of the injured ulnar nerve were restored to a certain extent. Moreover, multiple ampliifcation was subsequently detected in ulnar nerve axons.

  4. Semiconductors bonds and bands

    CERN Document Server

    Ferry, David K

    2013-01-01

    As we settle into this second decade of the twenty-first century, it is evident that the advances in micro-electronics have truly revolutionized our day-to-day lifestyle. The technology is built upon semiconductors, materials in which the band gap has been engineered for special values suitable to the particular application. This book, written specifically for a one semester course for graduate students, provides a thorough understanding of the key solid state physics of semiconductors. It describes how quantum mechanics gives semiconductors unique properties that enabled the micro-electronics revolution, and sustain the ever-growing importance of this revolution.

  5. The Wulf bands of oxygen

    Science.gov (United States)

    Bernath, Peter; Carleer, Michel; Fally, Sophie; Jenouvrier, Alain; Vandaele, Ann Carine; Hermans, Christian; Mérienne, Marie-France; Colin, Reginald

    1998-11-01

    The Wulf bands of oxygen in the 240-290 nm spectral region are caused by collision-induced absorption of the Herzberg III ( A' 3Δu- X3Σ-g) system. These bands had been previously attributed to the oxygen dimer, (O 2) 2. Under atmospheric conditions the Wulf bands are thus the long-wavelength extension of the Herzberg continuum. Absorption of solar radiation by the Wulf bands may be an additional source of NO in the stratosphere.

  6. [Strategy and critical analysis of bariatric surgery].

    Science.gov (United States)

    Houben, J J; Barea, M; Maroquin, L; Isabo, O; Desmarets, A

    2007-09-01

    Bariatric surgery has considerably developed during the last 20 years in Belgium. The increase of prevalence of the morbid obesity and the development of multiple surgical procedures widened the spectrum of treatment. If a rigorous selection and a multidisciplinary approach of the patients are inescapable, the various decision-making algorithms plunge the practitioner into a certain confusion. The purpose of this paper is to clarify the advantages and the inconveniences of the different surgical treatments in light of the evolution of the principles and the objective results of the literature. Among the techniques proven and validated in the long run, one can mention the Silastic Ring Vertical Gastroplasty according to Mac Lean by minilaparotomy, the laparoscopic adjustable ring and the more recent gastric by pass. The evaluation of laparoscopic sleeve gastrectomy, and of duodenal switch is on course. The bilio-pancreatic by-pass according to Scopinaro remains strongly controversed. A meta-analysis of the literature confirms the success of the gastric bypass. Regarding to the long term follow-up, the adjustable gastric banding deceives. The sleeve gastrectomy should be analyzed in the long term. The preliminary results of a epidemiologic and financial study within a private hospital of Brussels reveals that the cost effective ratio is in favor the Silastic Ring Vertical Gastroplasty and the laparoscopic adjustable banding, as well in terms of public health support than the charge for the private insurance and the patient. The projection beyond 5 years reverses the tendency to plead in favor of the gastric by-pass. First with the hit-parade of comfort, food diversification, tolerance, gastro-esophageal reflux, and undoubtedly of the rate of recurrence, it supplants the others techniques for sweet eaters. The volume eaters can profit from a sleeve gastrectomy which undoubtedly supplants the Silastic Ring Vertical Gastroplasty responsible for late annular stenoses and

  7. Analysis of the effect of total gastrectomy with vagus nerve preserved%保留迷走神经的全胃切除术疗效分析

    Institute of Scientific and Technical Information of China (English)

    桑温昌; 李兆德; 宫东尧; 张军; 王新征; 陈杰

    2011-01-01

    Objective To investigate the efficacy of total gastrectomy with vagus nerve preserved in patients with gastric cancer. Methods 63 patients received total gastrectomy with vagus nerve preserved ,while other 50 patients received total gastrectomy with vagus nerve severed as control . The post-operative symptoms , the postprandial symptoms , food intake, nutritional parameters and complication rates were compared between the two groups . Results The patients with vagus nerve preserved had less symptoms after operation than those with vagus nerve severed such as anorexia . nausea . helch . diarrhea and postcihal satiety ( P < 0. 05 ) . The Incidence of symptoms such as dysphagia , belch were significantly lower in the patients with vagus nerve preserved six months and one year after operation than those with vagus nerve severed ( P < 0. 05) . The post-operative complication rates , length of hospitalization and mortality rates were similar between the two groups (P > 0. 05 ). Conclusions The total gastrectomy with vagus nerve preserved is valuable procedures f'or gastric cancer .which can improve the quality of life .%目的 研究胃癌患者在全胃切除术中保留迷走神经的临床效果及应用前景.方法 对63 例胃癌患者行全胃切除术,术中保留迷走神经作为观察组;随机选择50 例未保留迷走神经的全胃切除术患者作为对照组,比较两组患者手术后的自觉症状、进食情况、营养状况及术后并发症发生率.结果 观察组患者较对照组患者术后在食欲、恶心、嗳气、腹泻、餐后饱胀感等方面有明显改善(P <0.05);术后6 个月和1 年时在吞咽困难、反流症状等方面,观察组患者明显优于对照组(P <0.05),两组患者在术后并发症发生率、住院时间及死亡率等方面相比较,差异无统计学意义(P>0.05).结论 保留迷走神经的全胃切除术能提高胃癌患者术后的生活质量,是比较理想的手术方式.

  8. Long-term changes in bone mass after partial gastrectomy in a well-defined population and its relation to tobacco and alcohol consumption

    DEFF Research Database (Denmark)

    Krogsgaard, M R; Frølich, A; Lund, B;

    1995-01-01

    We studied the long-term effect of partial gastrectomy on bone metabolism in a well defined population of gastrectomized patients compared to an age- and sex-matched group with unoperated peptic ulcers (controls). We selected 61 individuals between 61 and 70 years old at the time of investigation...... and insignificantly lower in the other operated groups. In men, ionized and total calcium was reduced, and 24-hour excretion of hydroxyproline in the urine as increased (p ... and unoperated patients in serum levels of alkaline phosphatases, iPTH, calcitriol, or the 24-hour urine calcium/creatinine excretion, even though there was a trend toward lower 24-hour urine calcium/creatinine ratio and increased levels in iPTH in the operated groups. There was no correlation between the daily...

  9. 一种新型滑套开关工具及配套技术应用研究%Application Research on A New Technology of Shifting Sleeves

    Institute of Scientific and Technical Information of China (English)

    石磊

    2014-01-01

    With the rapid development of horizontal well drilling technology,the staged reservoir stimulation technology and supporting tools of horizontal wells has become increasingly popular. As a component of the staged reservoir stimulation tool to communicating reservoir and wellbore,shiftable sliding sleeves are used to stimulate reservoir and to improve oil,gas and water management throughout the life of the well. Because of the large shifting force and extended reach required to operate sliding sleeves in horizontals,the coiled tubing(CT)is typically used for sleeve management. But there is some uncertainty to ensure sleeve shifted successfully by observing the change of surface load and there is a possibility of misuse. At the same time, this method can’t determine the sleeve position,so if the operation is not fully in place,CT operation was needed again. To solve this problem,this paper introduces a new shifting tool which is connected by CT with fiber. This tool can shifting sleeve by locating sleeve position precisely and monitoring string load,pressure and temperature in the downhole;by processing and interpreting the measurement data on the ground,the operators can judge the situation downhole accurately and switch sleeves reliably. It also can determine sleeve position by the change of CCL curve to save a lot of cost and time caused by operational errors.%随着水平井钻井技术的快速发展,水平井分段储层改造技术及配套工艺也越来越普及。作为分段储层改造工具管串中用来沟通储层与井筒的一个部件,可开关滑套通常用来实现储层改造及在整个井的生产周期内的油、气、水管理。由于滑套主要位于水平井段中,以及滑套开关所需力较大,通常采用连续油管带开关工具进行滑套开关操作;目前通过地面负载变化来判断井下滑套开关操作是否成功存在很大的不确定性和误操作的可能;同时,这种方法无法判断滑套

  10. 腹腔镜手术治疗残胃癌7例分析%Laparoscopic gastrectomy for gastric stump cancer:analysis of 7 cases

    Institute of Scientific and Technical Information of China (English)

    张人超; 徐晓武; 牟一平; 周育成; 周家瑜; 黄超杰; 许芸芸

    2016-01-01

    目的:探讨腹腔镜手术治疗残胃癌的安全性和可行性。方法回顾性分析2008年1月至2015年7月间在浙江省人民医院胃肠胰外科接受腹腔镜手术治疗的7例残胃癌患者的临床和随访资料。结果7例患者中男性5例,女性2例;年龄(62.1±10.7)岁;胃良性病变术后残胃癌4例,距胃首次手术时间6~30年;胃癌术后残胃再发癌3例,距胃首次手术时间11~15年。首次手术行BillrothⅡ术式者6例,Roux-en-Y术式者1例。本次手术分离腹腔粘连及探查腹腔后确定肿瘤位置后,行残胃切除加淋巴清扫术,然后进行食管空肠Roux-en-Y吻合。1例使用圆形吻合器行食管空肠端侧吻合;2例使用内镜直线切割闭合器食管空肠侧侧吻合;4例行手工缝合食管空肠吻合。手术时间(247.1±17.5) min;术中出血量(100.0±30.8) ml;术中均未输血。淋巴结清扫(19.1±4.8)枚。术后肛门排气时间(3.3±1.5) d;进食流质时间(3.7±0.8) d,住院时间(9.4±2.6) d。1例患者术后出现消化道出血,保守治疗后痊愈;无围手术期死亡者。术后7例均获得随访,随访时间截至2016年1月。随访6~38月。1例术后17月死于腹腔转移,1例术后19月死于阿尔茨海默病。存活的5例至今无肿瘤复发或转移。结论腹腔镜手术治疗残胃癌安全可行。%Objective To evaluate the safety and feasibility of laparoscopic gastrectomy for gastric stump cancer. Methods Clinical and follow-up data of 7 patients who underwent laparoscopic gastrectomy for gastric stump cancer in our department from January 2008 to July 2015 were analyzed retrospectively. Results There were 5 male and 2 female patients, with a mean age of (62.1 ±10.7) years. Initial gastrectomy was performed for gastric cancer in 3 patients and peptic ulceration in 4. The initial surgery was B-Ⅱ gastrojejunostomy in 6 patients and Roux-en-Y gastrojejunostomy in 1

  11. Combustion-driven oscillation in a furnace with multispud-type gas burners. 4th Report. Effects of position of secondary air guide sleeve and openness of secondary air guide vane on combustion oscillation condition; Multispud gata gas turner ni okeru nensho shindo. 4. Nijigen kuki sleeve ichi oyobi nijigen kuki vane kaido no shindo reiki ni oyobosu eikyo

    Energy Technology Data Exchange (ETDEWEB)

    Akiyama, I.; Okiura, K.; Baba, A.; Orimoto, M. [Babcock-Hitachi K.K., Tokyo (Japan)

    1994-07-25

    Effects of the position of a secondary air guide sleeve and the openness of a secondary air guide vane on combustion oscillation conditions were studied experimentally for multispud-type gas burners. Pressure fluctuation in furnaces was analyzed with the previously reported resonance factor which was proposed as an index to represent the degree of combustion oscillation. As a result, the combustion oscillation region was largely affected by both position of a guide sleeve and openness of a guide vane. As the openness having large effect on the ratio of primary and secondary air/tertiary air and the position hardly having effect on the ratio were adjusted skillfully, the burner with no combustion oscillation region was achieved in its normal operation range. In addition, as the effect of preheating combustion air was arranged with a standard flow rate or mass flow flux of air, it was suggested the combustion oscillation region due to preheating can be described with the same manner as that due to no preheating. 5 refs., 8 figs.

  12. Root cause of thermal sleeve loosening in optimized power reactor 1000 unit 5 and 6 Part (I) - A theoretical approach to the root cause and probabilistic revision of acceptance criterion at explosive expansion -

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Sang Gyu; Jung, Sung Yeop; Kim, Sang Nyung [Kyunghee University, Youngin (Korea, Republic of)

    2008-04-15

    Four of safety injection (SI) nozzles in a 1000 MWe-class Optimized Power Reactor (OPR-1000) are fitted with thermal sleeves (T/S) to alleviate thermal fatigue. Thermal sleeves in no3 and no4 of Younggwang (YGN) and Ulchin (UCN) nuclear power plant are manufactured out of Inconel-600 and fitted solidly without any problem, whereas YGN and UCN in no5 and no6, also fitted with thermal sleeves made of Inconel-690 for increased corrosion resistance, experienced a loosening of thermal sleeves except T/S of YGN no5-1A. To identify the root cause of T/S loosening, three suspected causes were analyzed: (1) the shear force of flow on the T/S when the safety SI nozzle was in operation, (2) the differences between Inconel-600 and Inconel-690 in terms of physical and chemical properties (notably the thermal expansion coefficient), and (3) the positioning error in explosive expansion of the T/S as well as the asymmetric expansion of T/S. It was confirmed that none of the three suspected causes could be considered as the root cause. However, after reviewing the design change history from the Palo Verde nuclear power plant to YGN and UCN no3,4 and no5,6, it was realized that the two stage design modifications (in terms of groove depth and material) made an additional explosive energy required by 172% in aggregate, but the amount of gunpowder and the explosive expansion method were the same as before, resulting in insufficient explosive force that led to poor thermal sleeve expansion. T/S measurement data and rubbing copies also support this conclusion. And the T/S loosening was also attributable to lenient quality control before and after fitting the T/S that resulted in significant uncertainty. In addition, it is our judgment that the acceptance criterion applicable to T/S fitting was not strict enough, failing to single out thermal sleeves that were not expanded sufficiently. Lastly, the acceptance criterion was scientifically revised to incorporate the thinning effect and

  13. Impact of minimally invasive/bariatric surgery fellowship on perioperative complications and outcomes in the first year of practice

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2013-01-01

    Full Text Available Background: Several reports have described worse perioperative outcomes of laparoscopic gastric bypass procedure during learning curve, which improved after completion of one-year fellowship training. Aims: The aim of this study was to evaluate the immediate impact of fellowship training on perioperative complications and outcomes of various bariatric procedures. Materials and Methods: One hundred initial patients who underwent laparoscopic gastric banding, laparoscopic Roux-en-Y gastric bypass, laparoscopic vertical sleeve gastrectomy, and robotically-assisted laparoscopic biliopancreatic diversion with duodenal switch by a single fellowship trained surgeon were analyzed. Results: Overall average Body Mass Index (BMI of the patients was 45.9 kg/m 2 , age was 47.5 years, and the American Society of Anesthesiologist Score was 2.89. There were no intraoperative, major 30-day complications, or open conversions. Average operative time was 62 minutes in gastric banding, 160 minutes in gastric bypass, 119 minutes in vertical sleeve gastrectomy, and 320 minutes in biliopancreatic diversion. Length of stay ranged from 0.5 day after gastric banding to 3.9 days after biliopancreatic diversion. The perioperative complications and outcomes are comparable with those reported by experienced surgeons. No mortality occurred in this series. Conclusions: Bariatric fellowship ensured skills acquisition for new surgeons to safely and effectively perform various types of bariatric operations, with minimal perioperative complications and excellent outcomes.

  14. Causes and Timing of Nonelective Reoperations After Bariatric Surgery: A Review of 1304 Cases at a Single Institution.

    Science.gov (United States)

    Thompson, Erin; Ferrigno, Lisa; Grotts, Jonathon; Knox, Jenna; Sobelman, Samantha; Thoman, David; Bounoua, Farida; Zerey, Marc

    2015-10-01

    As the number of patients undergoing bariatric procedures for weight loss increases, an understanding of the causes and timing of complications requiring reoperation is critical. The aim of our study was to characterize the type and timing of nonelective (NE) reoperations in these patients. Over five years, 1304 patients undergoing index procedures were identified: 769 laparoscopic Roux-en-Y gastric bypasses (LRYGB), 301 laparoscopic sleeve gastrectomies, and 234 laparoscopic adjustable gastric bands. We identified 117 NE reoperations, which were grouped by index procedure as well as whether they occurred early (≤90 days) or late (>90 days). In the laparoscopic adjustable gastric bands group, slipped gastric band was the most common indication for early (n = 2) and late (n = 2) reoperations. Biliary disease was the most common cause for early reoperations (n = 4), and the only cause for late reoperations (n = 2) after laparoscopic sleeve gastrectomies. For LRYGB, diagnoses differed between the early and late groups, with the most common early indications being bowel obstruction (n = 8) and anastomotic leak (n = 4) of the 18 early reoperations, and internal hernia (n = 36) and biliary disease (n = 17) of the 82 late reoperations. The vast majority of NE reoperations were performed laparoscopically (92%), with conversions and primarily open procedures only occurring in the LRYGB group.

  15. 压裂管柱中陶粒对滑套球座影响%Influence of Sand in Fracturing String on Sleeve Tee

    Institute of Scientific and Technical Information of China (English)

    刘景超; 刘超; 王晓

    2016-01-01

    目的:防止陶粒对滑套球座产生破坏。方法利用有限元软件 LS-DYNA 对陶粒冲击滑套球座进行建模,分别改变陶粒与滑套球座表面涂层之间的摩擦系数、滑套球座涂层的厚度、陶粒的粒径、陶粒的速度和陶粒速度相对于滑套球座表面的角度,通过仿真结果观察参数变化对滑套球座表面应力的影响。结果随着陶粒和球座之间的静摩擦系数由0.1增加到0.4,球座的最大表面应力由1.67 GPa增加到2.33 GPa。随着球座表面涂层厚度由3µm增大到6µm,球座的最大表面应力由2.05 GPa减小到0.89 GPa。随着陶粒粒径由50µm增加到80µm,球座的最大表面应力由1.67 GPa增加到3.63 GPa。随着陶粒速度由24 m/s增加到96 m/s,球座的最大表面应力由0.96 GPa增加到2.42 GPa。随着陶粒和球座表面之间的夹角由15°增加到60°,球座的最大表面应力由1.67 GPa增加到4.12 GPa。结论压裂液的性能会影响陶粒和球座之间的摩擦系数,进而影响球座的表面应力大小。球座的表面涂层厚度适当增大可以降低其表面的最大应力,压裂液中陶粒的直径越大,单个陶粒对球座造成的冲击应力越大。可以通过设计使滑套球座表面与中心线的夹角尽量小,以减小球座的最大表面应力。施工排量的增大会加剧球座的破坏。%ABSTRACT:Objective To prevent damage of sleeve tee caused by sand.Methods Using the finite element software LS-DYNA, the impact of sand on sleeve tee was modeled. By changing the coefficient of friction between the ball seat surface and sand, the thickness of the coating, the diameter of sand, the speed of sand, the angle between sand velocity and sleeve tee surface, the effects of parameter changes on sleeve tee surface stress were observed by simulation results.Results With the stat-ic coefficient of friction between the sand and the ball seat increasing from 0.1 to 0.4, the maximum surface

  16. Theoretical Simulation for Identical Bands

    Institute of Scientific and Technical Information of China (English)

    CHEN Yong-Jing; CHEN Yong-Shou; GAO Zao-Chun

    2004-01-01

    @@ The frequency of occurrence of identical bands is studied by analysing a large number of rotational bands calculated with the reflection asymmetric shell model, and the statistical properties of identical bands indicated in all the experimental observations are reproduced within the mean field approximation and beyond mean field treatment, such as angular momentum projection. The distributions of the calculated J(2), Eγ and the fractional change of J(2) are discussed.

  17. Cluster banding heat source model

    Institute of Scientific and Technical Information of China (English)

    Zhang Liguo; Ji Shude; Yang Jianguo; Fang Hongyuan; Li Yafan

    2006-01-01

    Concept of cluster banding heat source model is put forward for the problem of overmany increment steps in the process of numerical simulation of large welding structures, and expression of cluster banding heat source model is deduced based on energy conservation law.Because the expression of cluster banding heat source model deduced is suitable for random weld width, quantitative analysis of welding stress field for large welding structures which have regular welds can be made quickly.

  18. Efeito imediato da utilização da joelheira elástica em indivíduos com osteoartrite Immediate effect of the elastic knee sleeve use on individuals with osteoarthritis

    Directory of Open Access Journals (Sweden)

    Flavio Fernandes Bryk

    2011-10-01

    Full Text Available INTRODUÇÃO: A osteoartrite (OA de joelho normalmente ocasiona dificuldades na realização de diversas atividades rotineiras, sendo um dos principais motivos de procura por serviços médicos e fisioterapêuticos. Existem diversas modalidades de tratamento, com resultados variados. A utilização da joelheira como recurso adjunto tem-se mostrado controversa na literatura. OBJETIVO: Analisar a eficácia imediata da joelheira elástica na dor e na capacidade funcional em indivíduos com OA de joelho. MÉTODOS: Foram analisados 74 sujeitos sintomáticos (132 joelhos com OA de joelho por meio dos testes Stair Climb Power Test (SCPT, Timed Up and Go (TUG e Caminhada de 8 Metros (C8M, além da escala visual analógica (EVA para dor. Os testes foram realizados com e sem joelheira; a ordem e a presença ou ausência das joelheiras durante os testes foram randomizadas e com avaliador cego. RESULTADOS: Foi encontrada diferença estatisticamente significante entre as duas situações comparadas (com e sem joelheira para EVA (P 0,1339. CONCLUSÃO: A joelheira elástica foi eficiente na melhora imediata da capacidade funcional e da dor em indivíduos com OA de joelho, pois melhorou o desempenho durante os testes propostos. Sendo assim, entende-se que se trata de um recurso coadjuvante para o tratamento da OAJ por ser prático, útil, de fácil emprego clínico e que pode auxiliar e/ou facilitar a realização de exercícios terapêuticos.BACKGROUND: Knee osteoarthritis (KOA is one of the major reasons for seeking medical and physical therapy services, because it usually causes difficulties in performing daily life activities. There are several types of treatment, with varied results. The use of knee sleeve as an adjuvant resource has been controversial in the literature. OBJECTIVE: To assess the immediate efficacy of elastic knee sleeve on pain and functional capacity of individuals with KOA. METHODS: Seventy-four patients (132 knees with symptomatic KOA

  19. Band calculation of lonsdaleite Ge

    Science.gov (United States)

    Chen, Pin-Shiang; Fan, Sheng-Ting; Lan, Huang-Siang; Liu, Chee Wee

    2017-01-01

    The band structure of Ge in the lonsdaleite phase is calculated using first principles. Lonsdaleite Ge has a direct band gap at the Γ point. For the conduction band, the Γ valley is anisotropic with the low transverse effective mass on the hexagonal plane and the large longitudinal effective mass along the c axis. For the valence band, both heavy-hole and light-hole effective masses are anisotropic at the Γ point. The in-plane electron effective mass also becomes anisotropic under uniaxial tensile strain. The strain response of the heavy-hole mass is opposite to the light hole.

  20. Scarless platysmaplasty for platysmal bands

    Directory of Open Access Journals (Sweden)

    Shiffman Melvin

    2004-01-01

    Full Text Available Transection of plastysmal bands has required a surgical approach that leaves scars and limits patient activities for a period of time. The author has developed a simple method to transect the platysmal bands under local anesthesia without resorting to skin incisions. The transection is performed with the use of a Vicryl ® suture that is inserted through the skin, around the platysmal band, and then out through the original entry point. A back and forth motion of the suture cuts through the band.

  1. Iliotibial band Z-lengthening.

    Science.gov (United States)

    Richards, David P; Alan Barber, F; Troop, Randal L

    2003-03-01

    Iliotibial band friction syndrome (ITBFS) is a common overuse injury reported to afflict 1.6% to 12% of runners. It results from an inflammatory response secondary to excessive friction that occurs between the lateral femoral epicondyle and the iliotibial band. Initial treatments include rest, anti-inflammatory medication, modalities (ice or heat), stretching, physical therapy, and possibly a cortisone injection. In recalcitrant cases of ITBFS, surgery has been advocated. This report describes a surgical technique of Z-lengthening of the iliotibial band in patients presenting with lateral knee pain localized to the iliotibial band at the lateral femoral epicondyle and Gerdy's tubercle who failed all nonoperative efforts.

  2. Therapeutic effect analysis of reoperation in the treatment of upper gastrointestinal bleeding after gastrectomy%胃切除术后上消化道大出血的再手术治疗效果分析

    Institute of Scientific and Technical Information of China (English)

    杨文斌

    2016-01-01

    Objective:To analyze the clinical therapeutic effect of reoperation in the treatment of upper gastrointestinal bleeding after gastrectomy.Methods:46 cases of patients with upper gastrointestinal bleeding after gastrectomy were treated with reoperation.The curative effect of reoperation was observed.Results:After reoperation,31 cases were cured,13 cases were effective and the total effective rate was 95.65%.The incidence rate of postoperative complication was 4.35%.Conclusion:Reoperation was the effective method in the treatment of upper gastrointestinal bleeding after gastrectomy.%目的:分析再手术治疗胃切除术后上消化道大出血的临床疗效。方法:收治胃切除术后上消化道大出血患者46例,均行再次手术治疗。观察再次手术治疗效果。结果:再次手术后,痊愈31例,有效13例,总有效率95.65%。术后并发症发生率4.35%。结论:再手术是治疗胃切除术后上消化道大出血的有效方法。

  3. Application of laparoscope-assisted gastrectomy with D2 lymphadenectomy%腹腔镜辅助下胃癌D2根治术应用现状

    Institute of Scientific and Technical Information of China (English)

    王道荣; 鱼海峰

    2009-01-01

    国内外多数学者认为胃癌D2根治术是标准的胃癌手术方式.腹腔镜辅助下胃癌D2根治术安全、可行,能够达到与开腹手术相当的根治效果,且具有创伤小、术后恢复快等优点.本文就腹腔镜辅助胃癌D2根治术的概况、必要性、可行性、手术适应证、术中注意事项、术前评估、术后并发症、疗效和展望等方面进行总结.%Gastrectomy with D2 lymphadenectomy is considered as the standared operation to treat gastric cancer by the major of experts at home and abroad.Laparoscopic gastrectomy with D2 lymphadeneetomy is safe,feasible, minimally invasive and can achieve the same result of abdominal opening.This article is a review to summarize the overview,necessity and feasibility,the indication,the points for attention in operation,preoperative evaluation, complication,the result and the perspect about lapamscopie gastrectomy with D2 lymphadenectomy.

  4. Garage Band or GarageBand[R]? Remixing Musical Futures

    Science.gov (United States)

    Vakeva, Lauri

    2010-01-01

    In this paper, I suggest that it is perhaps time to consider the pedagogy of popular music in more extensive terms than conventional rock band practices have to offer. One direction in which this might lead is the expansion of the informal pedagogy based on a "garage band" model to encompass various modes of digital artistry wherever this artistry…

  5. Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes – a retrospective cohort study

    OpenAIRE

    Ugale, Surendra; Gupta, Neeraj; Modi, Kirtikumar D; Kota, Sunil K.; Satwalekar, Vasisht; Naik, Vishwas; Swapna, Modukuri; Kumar, KVS Hari

    2014-01-01

    Background Remission of diabetes is seen in more than 60% of patients after bariatric surgery. There is extensive variability in the remission rates between different surgical procedures. We analyzed our database and aimed to develop an easy scoring system to predict the probability of diabetes remission after two surgical procedures i.e. Ileal Interposition coupled with Sleeve Gastrectomy (IISG) or Diverted Sleeve Gastrectomy (IIDSG). Methods In this retrospective study, we analyzed records ...

  6. Influence of upper limb motion on the design of garment sleeve ease%人体上肢运动对服装袖型松量设计的影响分析

    Institute of Scientific and Technical Information of China (English)

    孙鑫磊

    2012-01-01

    为了解决服装袖型松量设计与人体上肢运动关系的问题,结合人体上肢的形态结构及几种常规运动,重点测量了7种人体上肢运动状态下的人体上肢各个部位的尺寸变化,结合衣袖结构设计的相关理论,对人体上肢尺寸变化情况的数据进行了分析,得出了与各种上肢运动状态对应的袖型松量设计的基本要求,进而分析了人体上肢运动对服装袖型松量设计的影响.%In order to investigate the relations of garment sleeve design of the pine and the movement of human upper limb, seven kinds of human upper extremity dimensions of all parts of the upper limbs of the human body in motion were measured based on mor- phology and several regular movements of the upper limbs of the human body. Then through the data analysis of human upper limb size changes and the combination of related theories on sleeve structure design, the basic requirement of the upper limb that corresponds to the design of sleeve-type were put forward, and the effect of human upper limb motion on the design of garment sleeve loose is analyzed.

  7. Manufacturing of High Ductility Aluminum Bronze Porcelain Sleeve Flange by Centrifugal Casting%高塑性铝铁青铜瓷套法兰离心铸造工艺

    Institute of Scientific and Technical Information of China (English)

    王清宇

    2012-01-01

    介绍了铝铁青铜材料的特性以及瓷套法兰铸件的使用状况和力学性能要求.在生产过程中应用了离心铸造工艺,通过分析生产中易产生的缺陷及防止措施的实施,制定了合理的高塑性铝铁青铜铸件离心铸造生产工艺,并通过生产过程的控制,达到了生产优质合格瓷套法兰零件的目的.%The characteristics of aluminum bronze material, using conditions and requirement for mechanical properties of porcelain sleeve flange were expounded. The porcelain sleeve flamge was produced by centrifugal casting. Through analyzing defects and implementing measures for eliminating defects, the proper centrifugal casting process was presented. By controlling strictly production process, the qualified porcelain sleeve flange was produced successfully.

  8. Long Lake banding project, 1965

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This report summarizes the results of a banding project on Long Lake in 1965. The dates at the banding site were July 27th through August 8th. As in the past, the...

  9. 营养支持对近端胃次全切除术后血浆Ghrelin水平的影响%Effect of nutrition support on plasma ghrelin level after the proximal subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    王海涛; 卢麒丞; 王荣朝; 张云; 许军

    2011-01-01

    Objective To investigate the effect of nutrition support on plasma ghrelin level after the proximal subtotal gastrectomy. Methods Eighty-three patients with T1-3 N0-1 Mo gastric cancer underwent proximal subtotal gastrectomy were divided into two groups of A (enteral nutrition, 43 cases) and B(parenteral nutrition,40 cases). Plasma ghrelin levels were determined by RIA before and on the 1st ,3rd,5th,7th and 9th day after gastrectomy. Results Plasma ghrelin levels of two groups dropped to the nadir one day after gastrectomy, which were (33. 2±4. 2) % and (34.1±3. 7) % of the values before The recovery of plasma ghrelin levels on the 3rd day was greater in group A than that in group B[(47. 2+6. 2) % vs、 (38. 4±5. 7)%](P0. 05 ). Conclusion Compared to parenteral nutrition,enteral nutrition is better in promoting compensational secretion of ghrelin after proximal subtotal gastrectomy.%目的 研究营养支持对近端胃次全切除术后患者血浆ghrelin水平的影响.方法 选择83例行近端胃癌根治术的T1~3 N0~1M0胃癌患者,根据营养支持方式将患者分为肠内营养组(A组,43例)和肠外营养组(B组,40例).测定手术当天、术后第1、3、7、9天血浆ghrelin水平.结果 两组术后第1天血浆ghrlein水平下降至最低点,分别为术前的(33.2±4.2)%和(34.1±3.7)%.术后第3天,A组血浆ghrlein水平的回升快于B组[(47.2±6.2)% vs.(38.4±5.7)%](P<0.05);至术后第9天,两组的回升幅度才相仿,分别为术前的(70.4±5.9)%和(67.1±6.3)%(P>0.05).结论 肠内营养较肠外营养更能促进近端胃次全术后患者血浆ghrelin水平的恢复.

  10. CFG地基处理套筒钻施工工法浅析%On CFG Sleeve Drilling Construction Method of Foundation Treatment

    Institute of Scientific and Technical Information of China (English)

    赵显涛; 于淑艳

    2014-01-01

    CFG水泥粉煤灰碎石桩作为一种地基处理方法,在工程中得到越来越多的应用。桩和桩间土一起,通过褥垫层形成复合地基共同工作,可有效提高地基承载力。本文针对抚顺某工地 CFG 地基处理采用的套筒螺旋钻的施工工艺,浅析这种工艺在处理节理裂隙发育及断裂带岩体中的实际应用,为实际工程提供指导和参考。%CFG cement fly ash gravel pile as a foundation tre-atment method, obtained more and more applications in eng-ineering. Pile and soil between piles composite foundation for-med together, work together through the cushion, which can e-ffectively improve the bearing capacity of the foundation. Ai-ming at the construction site in Fushun CFG foundation treat-ment sleeve screw with dril construction process, analyze this process in the application in joint rock fracture and fracture treatment, to provide guidance and reference for practical engi-neering.

  11. Ballistic parameters of .177 (4.5 mm) caliber plastic-sleeved composite projectiles compared to conventional lead pellets.

    Science.gov (United States)

    Frank, Matthias; Schönekeß, Holger; Jäger, Frank; Herbst, Jörg; Ekkernkamp, Axel; Nguyen, Thanh Tien; Bockholdt, Britta

    2013-11-01

    The capability of conventional air gun lead pellets (diabolo pellets) to cause severe injuries or fatalities even at low kinetic energy levels is well documented in medical literature. Modern composite hunting pellets, usually a metal core (made of steel, lead, zinc, or a zinc and aluminum alloy) encased in a plastic sleeve, are of special forensic and traumatological interest. These projectiles are advertised by the manufacturers to discharge at higher velocities than conventional air gun pellets, thus generating very high tissue-penetrating capabilities. Lack of experimental data on these uncommon air gun projectiles induced this work. Ballistic parameters of 12 different caliber .177 (4.5 mm) composite pellets, discharged from two spring-piston air guns (Weihrauch HW 35, Webley CUB) and three pneumatic air guns (Walther LGR, Walther LG400, Walther LP300), were investigated using a ballistic speed measurement system and compared to a conventional diabolo pellet (RWS Meisterkugel) as reference projectile. Although overall results were inconsistent, for some projectile-weapon combinations (particularly spring-piston air guns), a significant change of the kinetic energy (-53 up to +48 %) to the reference projectile was observed. The data provided in this work may serve as a basis for forensic investigation as well as traumatological diagnosis and treatment of injuries caused by these uncommon projectiles.

  12. 袖阀管注浆封闭截水施工技术%Construction Technology of Water Truncation with Sleeve Valve Pipe

    Institute of Scientific and Technical Information of China (English)

    霍小妹

    2011-01-01

    Water gushes occurred during the foundation excavation construction of underground garage service building of some residential building in Taiyuan. After comparing different grouting technologies, grouting with sleeve valve pipe is selected to solidify the ground. Mix proportion and grouting pressure of slurry are analyzed. Problems during construction are introduced in detail such as construction process, equipments selection, holes arrangement and forming, slurry making and grouting. Points for attention are discussed. By the reinforcement measures, the soil properties can reach construction requirements, and the water gushing is controlled.%针对太原市某住宅楼地下车库基坑工程在土方开挖中遇到涌水现象,经注浆技术比较,选用袖阀管注浆法对土体进行固化止水.分析砂土中所注浆液的配合比和注浆压力,对注浆施工流程、机械选用、钻孔布置及钻孔、浆液配制、下管和注浆施工等问题进行详细介绍,对注浆过程注意事项进行探讨.经加固的土体能满足施工要求.

  13. 海管修复隔离套袖防腐设计%Corrosion Control Design for Isolation Sleeve of Repair Subsea Pipeline

    Institute of Scientific and Technical Information of China (English)

    阳利军; 张国庆; 李妍

    2016-01-01

    Aiming at Panyu platform to zhuhai onshore terminal gas subsea pipeline leak permanent repair isolation sleeve, corrosion control design is introduced in this article. Including the anticorrosion coating design and cathodic protection design. About anticorrosion coating, introduced the selection process, reference standards and application requirements. About cathodic protection, introduced the selection of cathodic protection parameters, the calculation process and reference standards.%本文针对番禺平台至珠海陆地终端的天然气输送海管泄漏点永久修复隔离套袖的防腐设计进行了介绍,包括防腐涂层设计和阴极保护设计。对于防腐涂层介绍了选择过程、标准依据及施工要求等,对于阴极保护介绍了参数的选取、计算过程和相关标准依据。

  14. 液压蓄能技术在射频识别滑套上的应用实践∗%The Application of the Hydraulic Accumulator Technology on the RFID Sleeve

    Institute of Scientific and Technical Information of China (English)

    赵晨熙; 戴文潮; 秦金立

    2016-01-01

    The existed common fracturing sleeves have the technological issues like restricted fracturing sta⁃ges, unachieved full bore of string, frequent tripping of switching tool�To address the issues, the possible applica⁃tion of hydraulic accumulator technology on the RFID sleeve has been studied�The key technologies of the applica⁃tion of hydraulic accumulator technology on the RFID sleeve have been analyzed�For the hydraulic accumulator, the structure and key parameters has been designed, the strength has been calculated and the hydraulic driving sys⁃tem has been designed�On this basis, the overall structural design, tool’ s trial⁃produce and ground performance test of hydraulic accumulator fracturing sleeve has been conducted�The theoretical calculations and ground test re⁃sults show that the hydraulic accumulator technology can be applied to downhole tools and achieve great effect�The study results can provide references for the safe application of RIFD sleeve.%常见的压裂滑套存在压裂级数受限、管柱不能实现全通径、开关工具频繁起下钻效率低等问题。鉴于此,开展了液压蓄能技术在射频识别滑套上应用的研究。分析了该技术在射频识别滑套工具上应用的关键技术点,开展了液压蓄能器结构设计、蓄能器关键参数设计、强度计算和液压驱动系统设计,并在此基础上进行了液压蓄能式压裂滑套的整体结构设计、工具试制及地面性能测试。理论计算和地面试验结果证明,液压蓄能技术可以应用于石油井下工具中,且能够收到良好的应用效果。研究结果可为射频识别滑套在现场的安全应用提供参考。

  15. MECHANICS PROPERTY ANALYSIS OF PREFABRICATED INNER SLEEVE-T SECTION BEAM-COLUMN JOINT%装配式钢管内套筒- T型件梁柱节点力学性能分析

    Institute of Scientific and Technical Information of China (English)

    张茗玮; 王燕; 舒慧

    2015-01-01

    为研究装配式钢框架钢管内套筒‐T型件梁柱连接节点力学性能,通过改变内套筒厚度对节点进行有限元分析,对其极限承载力、荷载‐位移滞回性能、耗能能力、破坏形态等进行深入研究。结果表明:增大内套筒厚度,可以提高节点极限承载力和耗能能力,当内套筒厚度大于柱壁厚度2 mm时,节点表现出良好的滞回性能;当内套筒厚度取值过大时,节点力学性能提升不明显;位移加载过程中,高强度对拉螺栓预拉力施加面的拉力值随内套筒厚度增大变化不明显。%In order to study the mechanical properties of prefabricated steel frame inner sleeve‐T section beam‐column joint ,finite element analysis of the nodes was carried out through changing the thickness of inner sleeve . Bearing capacity ,hysteretic behavior ,energy dissipation capacity and failure modes of nodes were analyzed deeply . The results showed that increasing the thickness of inner sleeve can improve the bearing capacity and energy dissipation capacity of the node ,and the node exhibited good hysteretic behavior when the thickness of inner sleeve was more than cylindrical wall two millimeters .When the thickness value of inner sleeve was high ,the changes of mechanical properties of the node were not obvious .In the process of displacement loading ,the changes of tensile force values of pretension applied surface with increasing the thickness of inner sleeve in the high strength split bolts was not obvious .

  16. Clinical comparison of laparoscopy-assisted radical gastrectomy and open radical gastrectomy in gastric cancer after endoscopic submucosal dissection%内镜黏膜下剥离术后复发胃癌行腹腔镜与开腹根治术的临床对比

    Institute of Scientific and Technical Information of China (English)

    魏法星; 陈志红; 蒋鹏程

    2014-01-01

    目的:评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术后复发胃癌行腹腔镜下胃癌根治术的安全性和优越性.方法:回顾性分析ESD术后复发胃癌行胃癌根治性切除术的61例患者的临床资料.其中,41例行腹腔镜辅助下胃癌根治术(腹腔镜组),20例行开腹胃癌根治术(开腹组).统计并对比分析两组患者的一般资料、手术相关指标以及术后恢复的相关资料.结果:两组患者的年龄、性别、肿瘤距切缘长度、清扫淋巴结数目、病理分期,术中损伤情况以及术后并发症等差异均无统计学意义(P均>0.05).与开腹组比较,腹腔镜组手术时间长,住院费用高(P均<0.01),但C-反应蛋白低、手术切口长度小、术中出血量少以及术后镇痛药物使用例数少、首次通气时间早、胃肠减压拔除时间早、首次进流质饮食时间早、腹腔引流管拔除时间早及住院天数短(P均<0.05).结论:腹腔镜胃癌根治术治疗ESD术后复发胃癌安全、有效,与开腹胃癌根治术比较,具有明显的创伤小,出血量少,恢复快等优势.%Objective:To evaluate the safety and superiority of laparoscopy-assisted radical gastrectomy (LARG) for gastric cancer after endoscopic submucosal dissection (ESD).Methods:A total of 61 patients who underwent laparoscopic-assisted radical gastrectomy (LARG group,n =41) or open radical gastrectomy (open group,n =20) for gastric cancer after ESD were retrospectively analyzed.The general data,indicators related to the operation and postoperative recovery of relevant information of two group patients were analyzed.Results:There were no differences in the age,gender,length of the tumor to the cut edge,number of cleaning lymph nodes,pathological staging,intraoperative injury,postoperative complications between LARG group and open group (both P > 0.05).Compared with the open group,LARG group had longer operative time and higher expenditure(both P <0

  17. Proximal Gastrectomy and total Gastrectomy Controlled Clinical Studies Gastroesophageal Junction Cancer Treatment%近端胃切除术和全胃切除术治疗食管胃结合部癌的临床对照研究

    Institute of Scientific and Technical Information of China (English)

    郭雅明; 李艳杰

    2014-01-01

    Objective To investigate the gastroesophageal junction cancer patients with proximal or total gastrectomy for application of clinical effect.Methods 2011——2013 in our hospital 70 cases of esophageal cancer patients gastric junction as This study,and were randomly divided into two groups manner,each 35 cases,which will be implemented proximal gastrectomy treatment were included in group A,will implement total gastrectomy group therapy into B,to assess clinical outcomes between the two groups,summarize the treatment experience.Results A,B groups in the operation time to be closer,no significant difference(P>0.05);in gastric cancer-specific assessment scale(QLQ-STO22)aspect,A restricted diet group than in group B to score advantage(P<0.05),while the more desirable places in group B(P<0.05)in altered taste,reflux aspects.Conclusion Patients with gastroesophageal junction cancer implement proximal or total gastrectomy therapy has a definite effect,and can give postoperative complications in patients with varying degrees of clinical attention needs to be adequate and in accordance with the actual need to select the appropriate surgical procedures.%目的:探讨在食管胃结合部癌患者中对近端或全胃切除术进行应用的临床效果。方法选取2011——2013年我院收治的70例食管胃结合部癌患者作为本次研究对象,并以随机数字表法方式将其分成2组,每组35例,将其中实施近端胃切除术治疗者纳入A组,将实施全胃切除术治疗者纳入B组,评估两组的临床治疗结局,总结治疗经验。结果A、B两组在手术时间上要较为接近,比较差异不明显(P>0.05);在胃癌特异性评估量表(QLQ-STO22)方面,A组的饮食受限评分要较B组更具优势(P<0.05),而在味觉改变、反流方面则以B组更理想(P<0.05)。结论为食管胃结合部癌患者实施近端或全胃切除术治疗均有确切效果,且术后均可能给患者带来

  18. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies.

    Science.gov (United States)

    Tack, Jan; Deloose, Eveline

    2014-08-01

    Bariatric surgical procedure are increasingly and successfully applied in the treatment of morbid obesity. Nevertheless, these procedures are not devoid of potential long-term complications. Dumping syndrome may occur after procedures involving at least partial gastric resection or bypass, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy. Diagnosis is based on clinical alertness and glucose tolerance testing. Treatment may involve dietary measures, acarbose and somatostatin analogues, or surgical reintervention for refractory cases. Gastro-esophageal reflux disease (GERD) can be aggravated by vertical banded gastroplasty and sleeve gastrectomy procedures, but pre-existing GERD may improve after RYGB and with adjustable gastric banding. Nutrient deficiencies constitute the most important long-term complications of bariatric interventions, as they may lead to haematological, metabolic and especially neurological disorders which are not always reversible. Malabsorptive procedures, poor postoperative nutrient intake, recurrent vomiting and poor compliance with vitamin supplement intake and regular follow-up are important risk factors. Preoperative nutritional assessment and rigourous postoperative follow-up plan with administration of multi-vitamin supplements and assessment of serum levels is recommended in all patients.

  19. Squeezing effect in the high-frequency vibratory penetration process of the cast-in-place pile sleeve%灌注桩套管高频振动贯入过程中挤土效应研究

    Institute of Scientific and Technical Information of China (English)

    肖勇杰; 陈福全; 林良庆

    2015-01-01

    With the development of the technique for constructing the cast-in-place piles with high frequency vibratory hammers, the cast-in-place piles have been widely used in construction engineering. The penetration mechanism of the pile sleeve driven by high frequency vibratory hammers remains unclear, and particularly the squeezing effect in the sleeve penetration has yet to be investigated. In this paper, a finite elements and infinite elements coupling model is developed for simulating the sleeve penetration process driven by high frequency vibratory hammers, and used to study the squeezing effects such as ground heaves, lateral soil displacement and excess pore pressure generation. The results indicate that the horizontal displacement induced by soil compaction increases with the increase of sleeve penetration depth, and for the vertical compaction displacement, the heave increases in shallow soil layers and the settlement increases in deep soil layers as the sleeve penetration depth increases. The maximum compaction displacement lags behind the sleeve penetration depth. The reason for heave in shallow soil layers is that the horizontal stress increment causes an increase in the vertical stress, and the depth of heave interface increases with the increase of dynamical load amplitude, while decreases with the increase of vibration frequency. The excess pore pressure increases with the increase of sleeve penetration depth, and exhibits an exponential attenuation trend as the radial distances increases.%随着全套管振动取土灌注桩施工工艺的发展,灌注桩在工程中的应用越来越广泛,但关于灌注桩套管高频振动贯入机制,特别是套管贯入引起的挤土效应研究还不全面。全面介绍了套管高频振动贯入全过程的有限元-无限元耦合模型的建立过程后,对地表隆起、土体侧移及超孔隙水压力等挤土效应的变化规律进行了详细研究。研究结果表明:水平向的挤土

  20. Analysis and Experimental Research on Erosion of Cementing Sliding Sleeve%套管固井滑套冲蚀磨损模拟分析与试验研究

    Institute of Scientific and Technical Information of China (English)

    魏辽; 韩峰; 陈涛; 郭朝辉; 朱玉杰

    2014-01-01

    为准确分析套管固井滑套长时间在固液两相流中冲蚀后的磨损情况及可靠性,在进行冲蚀理论分析和数值模拟的基础上,利用研制的冲蚀磨损试验装置,研究了特定工况下固井滑套带孔短节的冲蚀磨损情况,分析了滑套孔眼冲蚀磨损速率与孔眼数量、砂比及排量的关系,建立了冲蚀磨损速率新模型,研究了滑套带孔短节孔眼过流能力与冲蚀磨损速率的关系;同时,结合数值分析结果和试验数据,得到了A型材质滑套短节的冲蚀磨损系数。研究结果表明,当滑套孔眼为2个时,含砂流体对滑套孔眼周边的冲蚀磨损较为明显,且滑套孔眼冲蚀磨损速率与砂比呈线性关系,与排量呈指数关系。该研究结果可为套管固井滑套可靠性评估提供理论依据,且能够指导滑套压裂工具的现场应用。%In order to analyze the wear rate and reliability of cementing sliding sleeve after high dis-charge ,high sand-fluid ratio and long-term erosion of solid-liquid flow ,downhole tools’ erosion and wear were researched based on the erosion theory and numerical simulation .The effects of the number of ports , sand concentration and displacement on the wear rate were analyzed .New test equipment was designed and built to test the erosion wear of port collar of cementing sliding sleeve under certain working conditions .A new model of erosion rate was established and more research was conducted about the flow capacity of port collar of cementing sliding sleeve and its effect on the rate of erosion wear .By combining numerical analysis and test data ,the erosion coefficient of cementing sliding sleeve made by type A material was obtained .Re-sults showed that the hole erosion was more severe when the cementing sliding sleeve contains two holes . The erosion rate had a linear relationship with sand concentration and an exponential relationship with fluid displacement .T his research

  1. Microstrip microwave band gap structures

    Indian Academy of Sciences (India)

    V Subramanian

    2008-04-01

    Microwave band gap structures exhibit certain stop band characteristics based on the periodicity, impedance contrast and effective refractive index contrast. These structures though formed in one-, two- and three-dimensional periodicity, are huge in size. In this paper, microstrip-based microwave band gap structures are formed by removing the substrate material in a periodic manner. This paper also demonstrates that these structures can serve as a non-destructive characterization tool for materials, a duplexor and frequency selective coupler. The paper presents both experimental results and theoretical simulation based on a commercially available finite element methodology for comparison.

  2. Band head spin assignment of superdeformed bands in 86Zr

    Science.gov (United States)

    Dadwal, Anshul; Mittal, H. M.

    2016-11-01

    Two parameter expressions for rotational spectra viz. variable moment of inertia (VMI), ab formula and three parameter Harris ω 2 expansion are used to assign the band head spins (I 0) of four rotational superdeformed bands in 86Zr. The least-squares fitting method is employed to obtain the band head spins of these four bands in the A ∼ 80 mass region. Model parameters are extracted by fitting of intraband γ-ray energies, so as to obtain a minimum root-mean-square (rms) deviation between the calculated and the observed transition energies. The calculated transition energies are found to depend sensitively on the assigned spins. Whenever an accurate band head spin is assigned, the calculated transition energies are in agreement with the experimental transition energies. The dynamic moment of inertia is also extracted and its variation with rotational frequency is investigated. Since a better agreement of band head spin with experimental results is found using the VMI model, it is a more powerful tool than the ab formula and Harris ω 2 expansion.

  3. Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach: a review of the literature published from 2000 to 2014.

    Science.gov (United States)

    Nakamura, Masaki; Yamaue, Hiroki

    2016-05-01

    Proximal gastrectomy (PG) is occasionally performed to preserve the physiological function of the remnant stomach with the aim of maintaining a gastric reservoir for patients with early gastric cancer in the upper third of the stomach. Many reconstructive procedures after PG have been reported, including esophagogastrostomy (EG), jejunal interposition, jejunal pouch interposition, and double tract. However, no general agreement exists regarding the optimal reconstructive procedure. This article reviews the current reconstructive procedures available for PG. We examined the surgical outcomes, postoperative complications, endoscopic findings, and quality of life (QOL) according to the reconstructive procedures. We found no significant difference in anastomotic leakage and anastomotic stricture among the procedures. The frequency of reflux esophagitis was higher with simple EG compared with the other reconstructive procedures. Some additional procedures, such as fundoplication, the use of a narrow gastric conduit, and placement of a gastric tube in the lower mediastinum on EG, could decrease the frequency of reflux esophagitis and reflux symptoms. These additional procedures may improve the QOL; however, the previous studies were small and could not adequately compare the reconstructive procedures. Prospective randomized controlled trials that involve a longer trial period and more institutions are needed to clarify the optimal reconstructive procedures after PG.

  4. U and Pu Gamma-Ray Measurements of Spent Fuel Using a Gamma-Ray Mirror Band-Pass Filter

    Energy Technology Data Exchange (ETDEWEB)

    Ziock, Klaus-Peter [ORNL; Alameda, J.B. [Lawrence Livermore National Laboratory (LLNL); Brejnholt, N.F. [Lawrence Livermore National Laboratory (LLNL); Decker, T.A. [Lawrence Livermore National Laboratory (LLNL); Descalle, M.A. [Lawrence Livermore National Laboratory (LLNL); Fernandez-Perea, M. [Lawrence Livermore National Laboratory (LLNL); Hill, R.M. [Lawrence Livermore National Laboratory (LLNL); Kisner, R.A. [Oak Ridge National Laboratory (ORNL); Melin, A.M. [Oak Ridge National Laboratory (ORNL); Patton, B.W. [Lawrence Livermore National Laboratory (LLNL); Ruz, J. [Lawrence Livermore National Laboratory (LLNL); Soufli, R. [Lawrence Livermore National Laboratory (LLNL); Pivovaroff, M.J. [Lawrence Livermore National Laboratory (LLNL)

    2014-01-01

    Abstract. We report on the use of grazing incidence gamma-ray mirrors to serve as a narrow band-pass filter for advanced non-destructive analysis (NDA) of spent nuclear fuel. The purpose of the mirrors is to limit the radiation reaching a HPGe detector to narrow spectral bands around characteristic emission lines from fissile isotopes in the fuel. This overcomes the normal rate issues when performing gamma-ray NDA measurements. In a proof-of-concept experiment, a set of simple flat gamma-ray mirrors were used to directly observe the atomic florescence lines from U and Pu from spent fuel pins with the detector located in a shirt-sleeve environment. The mirrors, consisting of highly polished silicon substrates deposited with WC/SiC multilayer coatings, successfully deflected the lines of interest while the intense primary radiation beam from the fuel was blocked by a lead beam stop. The gamma-ray multilayer coatings that make the mirrors work at the gamma-ray energies used here (~ 100 keV) have been experimentally tested at energies as high as 645 keV, indicating that direct observation of nuclear emission lines from 239Pu should be possible with an appropriately designed optic and shielding configuration.

  5. Technical Analysis and Performance Evaluation of Sliding Sleeve Seal%滑套密封技术分析与性能评估∗

    Institute of Scientific and Technical Information of China (English)

    余海燕; 雷中清; 冯强; 党伟; 周俊然; 王益山

    2015-01-01

    As an important tool of the slicing mining technology of petroleum and natural gas,sliding sleeves’ sealing performance directly affects on the slicing mining effect.Different sealing solutions used for the sliding sleeves were classi⁃fied and summarized,including the O⁃ring seal,lip seal,special seal and their different combination sealing forms.The seal⁃ing performances were evaluated for different forms of seals from five aspects,such as sealing effect,shearing resistance, wear resistance,service life and cost.By considering the five indicators synthetically,sleeve seals can choose simple star⁃rings,star⁃rings with apron,U⁃rings,double triangle rings of Tecom,and other forms of seals.Taking economy and practica⁃bility into consideration,simple O⁃rings and O⁃rings with flat apron are more applicable at slow speed and low pressure, and combination of O⁃rings and trapezoidal rings,fabric reinforced rubber combination V⁃ring seals,K⁃type seals of Tecom Manchester,T⁃rings of TeKanggelai are usually used at high pressure and large speed change.%滑套作为石油天然气分层开采技术的重要工具,其密封性能直接影响着施工的效果。对用于滑套的不同密封方案进行总结分类,包括O形圈密封、唇形密封、特殊型密封及其不同的组合密封形式;从密封效果、抗剪切性、耐磨性、使用寿命、成本5项指标对各类密封进行性能评估。综合考虑5项指标,滑套密封可选用简单星形密封圈、星形密封圈加挡圈、 U型密封圈、特康双三角密封圈等密封形式;而从经济实用方面来考虑,低压且速度不高时,可使用简单O形圈、 O形密封圈加平挡圈;压力较高且速度变化较大时,可使用O形圈和梯形环的组合、 V形夹织物橡胶组合密封圈、 K型特康斯特密封圈、 T型特康格来圈。

  6. 双套筒式碎石机油缸优化设计与应用%Optimization Design and Application of Double Sleeve Crusher Cylinder

    Institute of Scientific and Technical Information of China (English)

    王连富

    2016-01-01

    The crusher was the important basis of the tunneling efficiency when slurry shield machine unearthed in the stra-tum that was rich in pebbles and boulders,it’s reliability directly affects the driving efficiency of slurry shield machine in this kind of geological condition.According to the difficulties and problems summing up and combined with Lanzhou Metro Line 1,the text found the root causation that caused the crusher had a high failure rate,then creatively put forward the meth-od and supporting measures to reduce the crusher fault by increased external protective sleeve.%碎石机是泥水盾构机在富含卵石或孤石地层中顺利掘进的重要保证,其可靠性直接影响泥水盾构机在该种地质条件下的掘进效率。结合兰州轨道1号线一期泥水盾构穿黄地铁隧道项目,针对碎石机在黄河上游富漂石地层中遇到的一系列困难和问题进行了总结分析,找到了碎石机系统故障频发的根本原因,并创造性地提出了通过增加外置保护套筒的方式降低碎石机故障的方法及其配套措施。

  7. William Band at Yenching University

    Science.gov (United States)

    Hu, Danian

    2008-04-01

    William Band (1906-1993) has been widely remembered by his American colleagues and students as ``a fine physicist and teacher,'' who taught at Washington State University in Pullman between 1949 and 1971 and authored Introduction to Quantum Statistics (1954) and Introduction to Mathematical Physics (1959). Not many, however, knew much about Band's early career, which was very ``uncommon and eventful.'' Born in England, Band graduated from University of Liverpool in 1927 with an MsSc degree in physics. Instead of pursuing his Ph.D. at Cambridge, he chose to teach physics at Yenching University, a prestigious Christian university in Beijing, China. Arriving in 1929, Band established his career at Yenching, where he taught and researched the theory of relativity and quantum mechanics, pioneered the study on low-temperature superconductivity in China, founded the country's first graduate program in physics, and chaired the Physics Department for 10 years until he fled from Yenching upon hearing of the attack on Pearl Harbor. It took him two years to cross Japanese occupied areas under the escort of the Communist force; he left China in early 1945. This presentation will explore Band's motivation to work in China and his contributions to the Chinese physics research and education.

  8. Principle of internal rotation structure and method of pattern making for fit-sleeve%合体袖的内旋结构原理与制板方法

    Institute of Scientific and Technical Information of China (English)

    胡毅; 刘治君

    2016-01-01

    针对传统制版方法的合体袖不能满足人体手臂运动舒适度和美观度等问题,对人体臂弯内旋形态与袖型结构内旋力学要求进行分析,结合欧美时尚潮流对合体袖的造型要求和结构参数统计,采用立体裁剪实验验证等方法,将合体袖内旋结构与圆度、角度、弯度、前斜做了综合研究。研究认为,通过改变前后袖缝线的长度差,增大前袖缝线袖弯形态,结合归拔工艺还原前后袖缝线的长度与形态差,就能产生内旋扭力形成内旋的结构原理,从而得到合体一片袖、合体两片袖的内旋扭力设计原理和内旋结构的制版方法。该制版方法设计出的合体袖样板改进了传统合体袖的结构设计与版型,大大提高了合体袖的着装舒适度和美观度。%The fit⁃sleeve achieved from the conventional pattern⁃making methods couldn′t satisfy the human arm motion comfort and aesthetic. In order to solve this problem, the design principles of torsion used in the state of internal rotation and the pattern make of the designs of internal rotation were analyzed. Combined fashion trends of Europe with the data structure analysis, a comprehensive research on the internal rotation state, roundness, angles, cambered angles and the front slopes of the sleeves, were made by draping experiments. The research suggests that the torsion of internal rotation for fit⁃sleeves with one⁃piece or two⁃piece can be generated by changing the length of the front sleeve line, and increasing the front sleeve line curve, and the blocking process is to combined restore the length and form difference. Based on the conventional physical designs and models, the new pattern⁃making is formed, which improves the conventional structure design and the version of the fit⁃sleeve, and increases the clothing comfort and beauty.

  9. 含肾上腺素的肿胀麻醉技术在袖套式包皮环切术中的应用%Application of tumescent anesthesia with adrenaline for sleeve circumcision

    Institute of Scientific and Technical Information of China (English)

    施问国; 牟北平; 郑玉林; 李罡; 高炎

    2011-01-01

    目的:探讨含肾上腺素的肿胀麻醉技术在袖套式包皮环切术中的安全性和有效性.方法:应用含肾上腺素30μg、利多卡因60mg共6ml肿胀液行肿胀麻醉,对170例受术者实施袖套式包皮环切术.结果:所有受术者麻醉满意,麻醉维持4~7h.术中皮下小动脉、小静脉痉挛,切断的小血管断端无流血,术后无反应性出血,皮肤无坏死,切口一期愈合.结论:袖套式包皮环切术时含肾上腺素30μg的肿胀麻醉方法是一种安全,简单和有效的麻醉方法.%Objective To explore the safety and efficacy of tumescent anesthesia with adrenaline for sleeve circumcision. Methods 170 cases of sleeve circumcision were performed under 6ml of tumescent anesthesia solution containing adrenaline 30μg and lidocaine 60mg. Results Satisfactory anesthesia results were obtained in all cases.Intraoperative subcutaneous arterioles and venules are in spasm and cut without bloodshed. Incisions were all healed in one stage with no infection, no delayed haemorrage and no adrenaline-induced skin necrosis. Conclusions The tumescent anesthesia with adrenaline 30μg is safe, simple and effective for sleeve circumcision.

  10. Application of Reaming Honing Technology in Valve Sleeve of Automobile Steering Gear%铰珩工艺在汽车转向器阀套中的应用研究

    Institute of Scientific and Technical Information of China (English)

    刘晓石

    2012-01-01

    A single - pass honing technology with super hard abrasive, named reaming honing technology, is used to solve the Sow accuracy and efficiency caused by the traditional honing technology which is used to machine the valve sleeve of automobile steering gear. The fixture and cutter proposal is given according to the machining characters of the valve sleeve, and the orthogonal test is used to investigate the effects of the reaming honing parameters on the machining performance. The reaming honing technology with the optimized parameters proves itself to solve the accuracy problem in the machining of valve sleeve effectively, as a result the match grinding processing is cancelled and the machining efficiency is improved.%针对传统珩磨工艺在汽车转向器阀套加工中存在的精度不足和效率不高问题,引入一种单冲程超硬磨料珩磨孔加工技术,即铰珩工艺.根据阀套的加工特点,设计相应的夹具和刀具方案,并通过正交试验法研究铰珩工艺参数对加工性能的影响.参数经过优化的铰珩工艺,有效解决了阀套内孔加工的精度问题,取消了配磨工序,提高了加工效率.

  11. Clincal observation on the treatment of redundant prepuce by sleeve circumcision%套袖式包皮环切术治疗包皮过长的临床观察

    Institute of Scientific and Technical Information of China (English)

    韦炳朝

    2012-01-01

      目的观察套袖式包皮环切术治疗包皮过长的临床疗效.方法80例包皮过长患者行套袖式包皮环切术,观察患者早期术后并发症、术后3个月性生活状况及手术满意度情况.结果80例患者术后3 d 出现包皮轻度水肿占31.3%,术后轻度疼痛占20%,术后3个月随访患者性功能均无减退,对手术满意者占95%.结论套袖式包皮环切术术后并发症少,不影响术后性功能,患者满意度高.%  Objective To observe the clinical effect of treament for patients of redundant prepuce by sleeve circumcision. Methods Study 80 cases of redundant prepuce by sleeve circumcision on the postoperative complication in the early time after operation, the status of sexual life and satisfaction of the patient 3 months after operation. Results 80 cases had foreskin mild edema in 31.3%, mild pain in 20% three days after surgery .All the patients had no decline in sexual life ,and accounted for 95% of surgical satisfaction after three months follow-up. Conclusion Sleeve circumcision has fewer postoperative complications, no affect sexual function and higher patient satisfaction .

  12. Index finger radial digital proper artery transfer and sleeve anastomosis to treat thumb digital artery defect%食指桡侧指固有动脉转位套入法治疗拇指断指

    Institute of Scientific and Technical Information of China (English)

    姚阳; 李崇杰

    2014-01-01

    Objective To investigate the effect of index finger radial digital proper artery transfer and sleeve anastomosis on treatment of thumb digital artery defect. Methods 10 cases of complete or incomplete thumb amputation with digital artery defect, but without tendon or nerve defect, were replanted by index finger radial digital proper artery transfer and sleeve anastomosis to thumb ulnar digital proper artery. Results All of 10 cases survived after operation, finger pulp was plump, color and lustre was florid. The patients were followed up for 10 months to 2 years, the hand function has obtained satisfactory recovery, and extrinsic feature was natural. Conclusion Index finger radial digital proper artery transfer and sleeve anastomosis is especially adaptive to the treatment of thumb digital artery defect.%目的:探讨食指桡侧指固有动脉转位套入法治疗拇指断指的疗效。方法对10例指动脉缺损而无肌腱神经缺损的拇指完全或不完全离断病例,采用食指桡侧指固有动脉转位与拇指尺侧指固有动脉行套入吻合法修复动脉,再植拇指。结果本组10例再植拇指均成活,指腹饱满,色泽红润,经6~24个月随访,患者手部功能恢复满意,外观自然,2例出现虎口狭窄,经手术改善。结论食指桡侧指固有动脉转位套入法适用于单纯拇指指动脉缺损的再植治疗。

  13. Research of the Influence of Sleeve on Rotor Loss and Temperature Rise of Brushless DC Motors%紧圈对无刷直流电动机转子损耗及温升的影响分析

    Institute of Scientific and Technical Information of China (English)

    赵南南; 刘卫国; 诸自强

    2012-01-01

    表贴式无刷直流电动机的永磁体和紧圈如果采用电导率较高的材料,在时间和空间谐波的影响下可能会产生明显的涡流损耗.利用有限元法计算了紧圈分别采用不锈钢和碳纤维两种电导率不同材料表贴式无刷直流电动机的转子涡流损耗,基于计算得到的涡流损耗利用解析集总参数热网络法对两台电机进行了热场分析,并通过实验验证了仿真结果.通过研究发现,采用碳纤维紧圈的电机转子涡流损耗明显减小,转子发热有效改善.%Due to relatively high electrical conductivity of permanent magnets and retaining sleeve of surface-ounted brushless DC machines, significant eddy current loss may be induced by both time and space magneto-motive force harmonics. In this paper, rotor eddy current losses of surface-mounted brushless DC machines with different sleeve materials, which were stainless steel and carbon fiber respectively, were calculated using finite element analysis. Thermal fields of the two machines were analyzed using analytical lumped-circuit method based on the obtained eddy current losses and the predicted temperature rises of machines were verified by experiment results. The research reveals that the rotor eddy current losses of the motor with carbon fiber sleeve were significantly reduced the rotor temperature rise is improved effectively.

  14. X-Band PLL Synthesizer

    Directory of Open Access Journals (Sweden)

    P. Kutin

    2006-04-01

    Full Text Available This paper deals with design and realization of a PLL synthesizer for the microwave X−band. The synthesizer is intended for use as a local oscillator in a K−band downconverter. The design goal was to achieve very low phase noise and spurious free signal with a sufficient power level. For that purpose a low phase noise MMIC VCO was used in phase locked loop. The PLL works at half the output frequency, therefore there is a frequency doubler at the output of the PLL. The output signal from the frequency doubler is filtered by a band-pass filter and finally amplified by a single stage amplifier.

  15. Reason Analyzing and Improving Methods for Burning Out of Camshaft Bearing Sleeves for 320 Diesel Engines%320柴油机凸轮轴轴承套烧坏原因分析及改进措施

    Institute of Scientific and Technical Information of China (English)

    李宁; 李志军

    2011-01-01

    This paper analyzes the reasons for that camshaft bearing sleeves of 320 series diesel engines are burnt out for many times during test-bed test, and proposes the improving methods for it.%本文针对一段时间内320系列柴油机台架试验时连续多次出现凸轮轴轴承套烧坏事故,通过分析找到引起事故原因,并提出改进措施。

  16. Holographic Multi-Band Superconductor

    CERN Document Server

    Huang, Ching-Yu; Maity, Debaprasad

    2011-01-01

    We propose a gravity dual for the holographic superconductor with multi-band carriers. Moreover, the currents of these carriers are unified under a global non-Abelian symmetry, which is dual to the bulk non-Abelian gauge symmetry. We study the phase diagram of our model, and find it qualitatively agrees with the one for the realistic 2-band superconductor, such as MgB2. We also evaluate the holographic conductivities and find the expected mean-field like behaviors in some cases. However, for a wide range of the parameter space, we also find the non-mean-field like behavior with negative conductivities.

  17. X-Band PLL Synthesizer

    OpenAIRE

    P. Kutin; Vagner, P.

    2006-01-01

    This paper deals with design and realization of a PLL synthesizer for the microwave X−band. The synthesizer is intended for use as a local oscillator in a K−band downconverter. The design goal was to achieve very low phase noise and spurious free signal with a sufficient power level. For that purpose a low phase noise MMIC VCO was used in phase locked loop. The PLL works at half the output frequency, therefore there is a frequency doubler at the output of the PLL. The output signal ...

  18. 胃癌根治术术后恢复期的饮食指导%Dietary Guidance of Gastrectomy Postoperative in Recovery

    Institute of Scientific and Technical Information of China (English)

    刘颖

    2015-01-01

    Objective To investigate the dietary guidance of gastric cancer patients after radical surgery in convalescence. Methods 140 patients with gastric cancer routine surgery in January 2013~January 2014 in our hospital,given a reasonable dietary guidance,to observe the eating and body nutritional status. Results This group of patients at admission to reduce the consumption recovery ratio,but 98.57%of the patients at discharge energy intake to meet their physical needs. Conclusion Gastrectomy patients in the postoperative recovery period,giving it a reasonable diet guidance help patients nutritional intake,which can accelerate the recovery of the body.%目的:探讨行胃癌根治术患者术后恢复期的饮食指导。方法选择2013年1月~2014年1月我院收治的140例行胃癌根治术的患者,给予合理饮食指导,观察其进食及身体营养情况。结果本组患者恢复期进食量比入院时减少,但出院时98.57%的患者摄入能量满足其身体需要。结论对行胃癌根治术的患者,在术后恢复期,给予其合理的饮食指导,有助于患者营养的摄入,能加速其身体的恢复。

  19. Metaphyseal bands in osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Suresh S

    2010-01-01

    Full Text Available An increasing number of patients with osteogenesis imperfecta are undergoing pamidronate therapy to prevent the incidence of fragility fractures. The authors herein report a child aged 3 years who received five cycles of pamidronate, resulting in metaphyseal bands, known as "zebra lines."

  20. Bands for girls and boys

    Institute of Scientific and Technical Information of China (English)

    王为成

    2001-01-01

    Like many people, you may be dreaming of a career(职业) as rock and roll stars. There are two ways to go about getting one. First is the traditional way. Find some friends and form a group. Learn to play the guitar or the drums. Write your own songs. Spend hours arguing about the band name. Then go out on the road.

  1. A PHOTONIC BAND GAP FIBRE

    DEFF Research Database (Denmark)

    1999-01-01

    An optical fibre having a periodicidal cladding structure provididing a photonic band gap structure with superior qualities. The periodical structure being one wherein high index areas are defined and wherein these are separated using a number of methods. One such method is the introduction...

  2. Familial band-shaped keratopathy.

    Science.gov (United States)

    Ticho, U; Lahav, M; Ivry, M

    1979-01-01

    A brother and sister out of a consanguinous family of four siblings are presented as prototypes of primary band-shaped keratopathy. The disease manifested sever progressive changes of secondary nature over two years of follow-up. Histology and treatment are described.

  3. K-Band Latching Switches

    Science.gov (United States)

    Piotrowski, W. S.; Raue, J. E.

    1984-01-01

    Design, development, and tests are described for two single-pole-double-throw latching waveguide ferrite switches: a K-band switch in WR-42 waveguide and a Ka-band switch in WR-28 waveguide. Both switches have structurally simple junctions, mechanically interlocked without the use of bonding materials; they are impervious to the effects of thermal, shock, and vibration stresses. Ferrite material for the Ka-band switch with a proper combination of magnetic and dielectric properties was available and resulted in excellent low loss, wideband performance. The high power handling requirement of the K-band switch limited the choice of ferrite to nickel-zinc compositions with adequate magnetic properties, but with too low relative dielectric constant. The relative dielectric constant determines the junction dimensions for given frequency responses. In this case the too low value unavoidably leads to a larger than optimum junction volume, increasing the insertion loss and restricting the operating bandwidth. Efforts to overcome the materials-related difficulties through the design of a composite junction with increased effective dielectric properties efforts to modify the relative dielectric constant of nickel-zinc ferrite are examined.

  4. K-band latching switches

    Science.gov (United States)

    Piotrowski, W. S.; Raue, J. E.

    1984-05-01

    Design, development, and tests are described for two single-pole-double-throw latching waveguide ferrite switches: a K-band switch in WR-42 waveguide and a Ka-band switch in WR-28 waveguide. Both switches have structurally simple junctions, mechanically interlocked without the use of bonding materials; they are impervious to the effects of thermal, shock, and vibration stresses. Ferrite material for the Ka-band switch with a proper combination of magnetic and dielectric properties was available and resulted in excellent low loss, wideband performance. The high power handling requirement of the K-band switch limited the choice of ferrite to nickel-zinc compositions with adequate magnetic properties, but with too low relative dielectric constant. The relative dielectric constant determines the junction dimensions for given frequency responses. In this case the too low value unavoidably leads to a larger than optimum junction volume, increasing the insertion loss and restricting the operating bandwidth. Efforts to overcome the materials-related difficulties through the design of a composite junction with increased effective dielectric properties efforts to modify the relative dielectric constant of nickel-zinc ferrite are examined.

  5. 基于正交实验的转向器阀套铰珩工艺优化的研究%Optimization of the reaming honing process of valve sleeve based on orthogonal test

    Institute of Scientific and Technical Information of China (English)

    杨筱蓉; 朱永伟; 齐翔; 徐正选

    2013-01-01

    Reaming honing process of valve sleeve are studied by orthogonal tests and theoretical analysis. Influence factors of honing quality are as follows: the roundness value are determined by spindle speed and feed speed; the surface roughness value are determined by diamond size; the honing straightness value are determined by position accuracy of machine spindle, re-positioning accuracy of bench and the positioning accuracy of clamp system. Finally, process parameters of reaming honing are optimized for the high quality machining of valve sleeve.%运用正交实验设计方法和理论分析对加工转向器阀套内孔的铰珩工艺进行了研究,确定了影响阀套内孔铰珩质量的因素.结果表明:主轴转速和进给速度是圆度的决定性因素;珩具金刚石粒度的大小决定了粗糙度大小;机床加工轴的位置精度、工作台重复定位精度和夹具系统的定位精度决定了铰珩直线度.最终优化了铰珩工艺参数,实现了阀套的高质量加工.

  6. 牙轮钻头轴承套装配应力有限元分析及试验%Finite Element Analysis of Assembly Stress and Application of Rock Bit Bearing Sleeve

    Institute of Scientific and Technical Information of China (English)

    何畏; 刘杰; 邓嵘; 汤海平; 徐彤

    2012-01-01

    应用弹性力学理论对新型牙轮钻头的轴承套过盈配合进行受力分析,指出该方法具有局限性.采用ANSYS有限元分析软件和接触问题的有限元法,对新型牙轮钻头轴承套的装配进行仿真研究,确定了装配过盈量的最佳值.通过试验验证了理论分析的正确性和结构改进的可行性.%Theoretically,the stress of bearing sleeve interference fit of new type rock bit by the e-lasticity mechanics theory was analyzed. Based on the ANSYS and finite element method of contact problem,make the Simulation Study of the new rock bit bearing sleeve assembly set. Thus determine assembly process parameters of the best value over interference magnitude. Through experimental verification,demonstrate the validity of the theoretical analysis and the constructa-bility of structure improvement.

  7. 底板组装过盈配合铜套内孔收缩量分析%Calculate on Shrinkage of The Endoporus of Copper Sleeve in Tight Fit

    Institute of Scientific and Technical Information of China (English)

    王福杰; 龚晓彬; 廖宁宁

    2015-01-01

    This paper introduces the common assembly method of tight fit, explores into the inner diameter of the copper in-terference with outside diameter shrinkage, calculated from the theory into the copper sleeve hole contraction, identify in practice how to easily find the shrinkage approach. This contraction in mechanical elements design, which will reflect on the inner hole size tolerance of copper, after the copper sleeve is pressed into the body, actual dimensions meet the requirements of shaft and hole fitting accuracy, both scientific and economic sense.%文章介绍了过盈配合常见的装配方法,探讨了压入铜套外径过盈量与内径收缩量的关系,从理论上计算出压入铜套的内孔收缩量,同时找出在实际工作中如何简便地求出收缩量的办法。从而在机械零件设计时将此收缩量反映到铜套内孔尺寸公差上,使铜套压入机体后,实际尺寸符合轴与孔要求的动配合精度,既科学又经济合理。

  8. Study on unplanned re-operation after radical gastrectomy for gastric cancer: Seven years' experience%胃癌根治术后非计划再手术35例

    Institute of Scientific and Technical Information of China (English)

    黄嫣妮; 钱雷敏; 黄建明; 戈军刚; 高林; 刘惠钧

    2013-01-01

    Objective To investigate the causes of unplanned re-operation following radical surgery for gastric cancer and to summarize clinical experience.Methods The clinical data of gastric cancer patients who underwent radical gastrectomy from Jan.2006 to Dec.2012 were retrospectively analyzed in the study,especially focusing on the preoperative,intraoperative and postoperative situations of unplanned re-operation cases at the same hospitalization.Results During seven years,radical gastrectomy for gastric cancer was implemented in 1707 cases,35 of which had unplanned re-operations.The rate of such re-operation was 2.05 %,following the mortality rate of 8.57%.Besides age,basic chronic illness and TNM stage,the primary operation way,which caused the higher incidence of unplanned re-operation,was radical total gastrectomy.Some complications after radical gastrectomy required unplanned re-operations,of which the most common was wound disruption and others,in turn,were pleural effusions/ascites,post-traumatic focal pancreatitis (PTFP),intestinal obstruction,intraperitoneal hemorrhage,while the most serious consequence was anastomotic leakage or stump fistula and partly led to death.Conclusion Unplanned re-operation after radical gastrectomy for gastric cancer can increase residential time,total treatment cost and the mortality rate.Comprehensive preoperative analysis,correct intraoperative and postoperative management,as well as timely treatment of complications are important measures to reduce the incidence of those unplanned re-operations.%目的 探讨胃癌根治术后非计划再手术的原因及总结临床治疗体会.方法 回顾性分析2006年1月—2012年12月间行胃癌根治术患者的临床资料,并重点分析同一住院期间非计划再手术病例的术前、手术及术后情况.结果 7年间共实施胃癌根治术1 707例,发生非计划再手术35例,再手术率2.05%,再手术死亡率8.57%.发生率较高者的初次手术方式为根治

  9. Ingestion of polydextrose increase the iron absorption in rats submitted to partial gastrectomy A ingestão de polidextrose aumenta a absorção de ferro em ratos submetidos à gastrectomia parcial

    Directory of Open Access Journals (Sweden)

    Elisvânia Freitas dos Santos

    2010-12-01

    Full Text Available PURPOSE: To investigate whether polydextrose stimulates iron absorption in rats submitted to partial gastrectomy and sham operated. METHODS: The rats were submitted to partial gastrectomy (Billroth II or laparotomy (sham-operated control, in groups of 20 and 20 each respectively. The animals were fed with a control diet (AIN-93M without polydextrose or a diet containing polydextrose (50g/Kg of diet for eight weeks. They were divided into four subgroups: sham-operated and Billroth II gastrectomy and with or without polydextrose. Two animals died during the experiment. All rats submitted to gastrectomy received B-12 vitamin (intramuscular each two weeks. The hematocrit and hemoglobin concentration were measured at the start and on day 30 and 56 after the beginning of the experimental period. At the end of the study, the blood was collected for determination of serum iron concentration. RESULTS: The diet with polydextrose reduced the excretion of iron. Apparent iron absorption was higher in the polydextrose fed groups than in the control group. The haematocrit and haemoglobin concentration were lower after Billroth II gastrectomy rats fed the control diet as compared to the polydextrose diet groups. CONCLUSION: Polydextrose increase iron absorption and prevents postgastrectomy anemia.OBJETIVO: Investigar se a polidextrose estimula a absorção de ferro em ratos submetidos à gastrectomia parcial e sham operados. MÉTODOS: Os ratos foram submetidos à gastrectomia parcial (Billroth II e à laparotomia (controle sham-operados em grupos de 20 e 20 cada, respectivamente. Os animais foram alimentados com uma dieta controle (AIN-93M, sem polidextrose ou uma dieta contendo polidextrose (50g/kg de dieta durante oito semanas. Foram divididos em quatro grupos: sham-operados e com gastrectomia BII e com ou sem polidextrose. Dois animais morreram durante o experimento. Todos os ratos com gastrectomia receberam vitamina B-12 (intramuscular a cada duas semanas

  10. ALMA Band 5 Cartridge Performance

    Science.gov (United States)

    Billade, Bhushan; Lapkin, I.; Nystrom, O.; Sundin, E.; Fredrixon, M.; Finger, R.; Rashid, H.; Desmaris, V.; Meledin, D.; Pavolotsky, A.; Belitsky, Victor

    2010-03-01

    Work presented here concerns the design and performance of the ALMA Band 5 cold cartridge, one of the 10 frequency channels of ALMA project, a radio interferometer under construction at Atacama Desert in Chile. The Band 5 cartridge is a dual polarization receiver with the polarization separation performed by orthomode transducer (OMT). For each polarization, Band 5 receiver employs sideband rejection (2SB) scheme based on quadrature layout, with SIS mixers covering 163-211 GHz with 4-8 GHz IF. The LO injection circuitry is integrated with mixer chip and is implemented on the same substrate, resulting in a compact 2SB assembly. Amongst the other ALMA bands, the ALMA Band 5 being the lowest frequency band that uses all cold optics, has the largest mirror. Consequently, ALMA Band 5 mirror along with its support structure leaves very little room for placing OMT, mixers and IF subsystems. The constraints put by the size of cold optics and limited cartridge space, required of us to revise the original 2SB design and adopt a design where all the components like OMT, mixer, IF hybrid, isolators and IF amplifier are directly connected to each other without using any co-ax cables in-between. The IF subsystem uses the space between 4 K and 15 K stage of the cartridge and is thermally connected to 4 K stage. Avoiding co-ax cabling required use of custom designed IF hybrid, furthermore, due to limited cooling capacity at 4 K stage, resistive bias circuitry for the mixers is moved to 15 K stage and the IF hybrid along with an integrated bias-T is implemented using superconducting micro-strip lines. The E-probes for both LO and RF waveguide-to-microstrip transitions are placed perpendicular to the wave direction (back-piece configuration). The RF choke at the end of the probes provides a virtual ground for the RF/LO signal, and the choke is DC grounded to the chassis. The on-chip LO injection is done using a microstrip line directional coupler with slot-line branches in the

  11. S-Band propagation measurements

    Science.gov (United States)

    Briskman, Robert D.

    1994-08-01

    A geosynchronous satellite system capable of providing many channels of digital audio radio service (DARS) to mobile platforms within the contiguous United States using S-band radio frequencies is being implemented. The system is designed uniquely to mitigate both multipath fading and outages from physical blockage in the transmission path by use of satellite spatial diversity in combination with radio frequency and time diversity. The system also employs a satellite orbital geometry wherein all mobile platforms in the contiguous United States have elevation angles greater than 20 deg to both of the diversity satellites. Since implementation of the satellite system will require three years, an emulation has been performed using terrestrial facilities in order to allow evaluation of DARS capabilities in advance of satellite system operations. The major objective of the emulation was to prove the feasibility of broadcasting from satellites 30 channels of CD quality programming using S-band frequencies to an automobile equipped with a small disk antenna and to obtain quantitative performance data on S-band propagation in a satellite spatial diversity system.

  12. An extension to flat band ferromagnetism

    Science.gov (United States)

    Gulacsi, M.; Kovacs, G.; Gulacsi, Z.

    2014-11-01

    From flat band ferromagnetism, we learned that the lowest energy half-filled flat band gives always ferromagnetism if the localized Wannier states on the flat band satisfy the connectivity condition. If the connectivity conditions are not satisfied, ferromagnetism does not appear. We show that this is not always the case namely, we show that ferromagnetism due to flat bands can appear even if the connectivity condition does not hold due to a peculiar behavior of the band situated just above the flat band.

  13. Comparison of Therapeutic Efficacy between Gastrectomy with Transarterial Chemoembolization Plus Systemic Chemotherapy and Systemic Chemotherapy Alone in Gastric Cancer with Synchronous Liver Metastasis

    Institute of Scientific and Technical Information of China (English)

    Sen-Feng Liu; Can-Rong Lu; Hai-Dong Cheng; Hong-Qing Xi; Jian-Xin Cui; Ji-Yang Li; Wei-Song Shen

    2015-01-01

    Background:Systemic chemotherapy (SC) is the recommended treatment for gastric cancer with liver metastasis.However,the improvement in survival has been disappointing.The aim of this study was to compare the therapeutic efficacy of gastrectomy with transarterial chemoembolization plus SC (GTC) and SC alone for gastric cancer with synchronous liver metastasis.Methods:From January 2008 to December 2013,107 gastric cancer patients with synchronous liver metastasis attending the four participating centers were enrolled in this multicenter,ambispective,controlled cohort study.Patients who underwent GTC (n =32) were compared with controls who were received SC alone (n =75).The primary endpoints of the study were overall survival (OS) and progression-free survival (PFS).The secondary endpoints were response rate to treatment and treatment-related adverse effects.Results:The median OS was 14.0 months (95% confidence interval [CI]:13.1-14.9 months) in the GTC treatment group and 8.0 months (95% CI:6.6-9.4 months) in SC group,this difference being statistically significant (P < 0.001).The median PFS was significantly longer in the GTC than in the SC group (5 months,95% CI:2.2-7.8 months vs.3 months,95% CI:2.3-3.4 months,respectively) (P < 0.001).The rate of response to treatment was significantly better in the GTC than the SC group (59.4% vs.37.4%,respectively) (P =0.035).According to multivariate analysis,OS in patients receiving combination treatment was significantly correlated with the size (P =0.037) and extent of liver metastases (P < 0.001).PFS was also correlated with the extent of liver metastases (P =0.003).Conclusions:GTC is more effective than SC alone in patients with gastric cancer with synchronous liver metastasis.GTC therapy prolongs the survival of selected gastric cancer patients with synchronous liver metastasis.

  14. Subtotal Gastrectomy With Billroth II Anastomosis Is Associated With a Low Risk of Ischemic Stroke in Peptic Ulcer Disease Patients: A Nationwide Population-Based Study.

    Science.gov (United States)

    Chen, Chien-Hua; Lin, Cheng-Li; Kao, Chia-Hung

    2016-04-01

    Duodenal diversion can ameliorate lipid and glucose metabolism. We assessed the risk of stroke after subtotal gastrectomy with Billroth II anastomosis (SGBIIA) in peptic ulcer disease (PUD). We identified 6425 patients who received SGBIIA for PUD between 1998 and 2010 from the Taiwan National Health Insurance Research Database as the study cohort; we frequency-matched them with 25,602 randomly selected controls from the PUD population who did not receive SGBIIA according to age, sex, index year, and comorbidities including hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), and obesity. All patients were followed until the end of 2011 to determine the incidence of stroke. The incidence of stroke was lower in patients in the SGBIIA cohort than in those in the non-SGBIIA cohort (18.9 vs 22.9 per 1000 person-years, adjusted hazard ratio [aHR] 0.80, 95% confidence interval [CI] 0.72-0.89, P < 0.001). The risk of ischemic stroke (aHR 0.77, 95% CI 0.69-0.86, P < 0.001), rather than hemorrhagic stroke (aHR 1.00, 95% CI 0.78-1.28), was lower for the SGBIIA cohort than for the non-SGBIIA cohort according to the multivariable Cox proportional hazard regression analysis. The relative risk of ischemic stroke after SGBIIA was lower in men (aHR 0.77, 95% CI 0.69-0.86) than in women (aHR 0.80, 95% CI 0.65-0.99) and in patients aged ≥65 years (aHR 0.72, 95% CI 0.63-0.81) than in those of other age groups (≤49 years, aHR 0.82, 95% CI 0.48-1.39; 50-64 years, aHR 1.01, 95% CI 0.79-1.28). The relative risk of ischemic stroke after SGBIIA was also reduced in patients with comorbidities (aHR 0.84, 5% CI 0.75-0.95) rather than in those without comorbidities (aHR 0.81, 95% CI 0.59-1.12). SGBIIA is associated with a low risk of ischemic stroke for PUD patients, and its protective effect is prominent in men, patients aged ≥65 years, and those with comorbidities.

  15. Mini-laparotomy with abdominal wall lifting for partial gastrectomy in patients with early gastric mucosal cancer at lesser curvature of the middle stomach.

    Science.gov (United States)

    Tomita, Ryouichi; Fujisak, Shigeru; Park, Yeong Ji

    2009-01-01

    Partial gastrectomy (PG) is the most frequently adopted minimally invasive procedure for early gastric cancer (EGC), especially mucosal cancer (MC). The aim of this study was to introduce a minimally invasive procedure, i.e., minilaparotomy with abdominal wall lifting for PG in patients with early mucosal gastric cancer at the lesser curvature of the middle stomach. Well differentiated adenocarcionoma in MC at the lesser curvature of the middle stomach was selected, where no lymph node metastasis (NO) was confirmed using ultrasonic endoscopy, CT, and MRI during the preoperative examinations. PG was also chosen for patients with a tumor size of 2cm or less and non-depressive type in whom endoscopic mucosal resection (EMR) or endoscopic submucosal resection (ESD) was not possible. Five MC patients (3 men and 2 women, aged 44-62 years, mean age 53.3 years) underwent mini-laparotomy with abdominal wall lifting for PG. Our procedure involved a 6 cm upper abdominal median incision made at the beginning of the operation. The upper abdominal wall was lifted by a subcutaneous Kirshner wire. The small wound was also pulled upward and/or laterally by Kent retractors and conventional surgical instruments were used through the wound. The middle stomach could be detected through the small wound and partially resected, approximately 1 cm from the tumor edge under the guide of the endoscope. The resected stomach margin was stitched layer-to-layer. In this way, PG was easily completed. The total surgical time was 71.8 +/- 12.9 min and the mean estimated blood loss was 30.8 +/- 20.5 ml. Day of starting diet was 3 +/- 0.7 days after operation. Post-operative hospitalization was 8.2 +/- 1.3 days. There was no surgical mortality. All subjects were satisfied with this procedure. Mini-laparotomy with abdominal wall lifting is a safe and efficient technique in the treatment of PG for MC with NO at the lesser curvature of the middle stomach when EMR or ESD is impossible.

  16. 3种包皮环切术的临床疗效分析%Shang Ring, sleeve and conventional circumcisions for redundant prepuce and phimosis:A comparative study of 918 cases

    Institute of Scientific and Technical Information of China (English)

    王荣; 陈伟军; 史文华; 薛一峰

    2013-01-01

    Objective: To compare the clinical effects of conventional, sleeve and Shang Ring circumcisions in the treatment of redundant prepuce and phimosis. Methods: We reviewed the clinical data of 918 patients with redundant prepuce or phimosis, 279 treated by conventional circumcision, 354 by sleeve circumcision and 285 by Shang Ring circumcision. We documented the preopera-tive characteristics, intra-operative blood loss, operation time, 4-hour and 7-day postoperative visual analogue scores, surgeons'satisfaction , incision healing time, degrees of preputial edema, postoperative complications, patients' satisfaction with penile appearance and peri-operative cost, and compared them among the three groups. Results: Shang Ring circumcision significantly reduced the operation time and intra-operative blood loss as compared with conventional and sleeve circumcisions (P <0. 05). The postoperative incision healing time was (18.6 ±5.2) d in the conventional circumcision group, (11.4 ±3.7) din the sleeve circumcision group and (20.3±5.7) d in the Shang Ring circumcision group, significantly shorter in the sleeve group than in the other two ( P < 0.05). As for the surgeons'satisfaction, postoperative complications, degree of preputial edema and patients'satisfaction with penile appearance, sleeve circumcision showed similar effects to Shang Ring circumcision but significantly better than conventional circumcision ( P < 0.05). The 7-day postoperative visual analogue score and peri-operative cost were significantly lower in the conventional and sleeve cir-cumcision groups than in the Shang Ring group (P < 0.05). Conclusion: Each of the three circumcision methods has its own advantages and disadvantages. The treatment decision should be individualized and based on a comprehensive consideration of the patients' age and economic status as well as surgeons'advice and surgical skills.%目的:比较传统包皮环切术、袖套状包皮切除术和包皮环切吻合术治疗

  17. The DSS-14 C-band exciter

    Science.gov (United States)

    Rowan, D. R.

    1989-01-01

    The development and implementation of a C-band exciter for use with the Block IV Receiver-Exciter Subsystem at Deep Space Station 14 (DSS-14) has been completed. The exciter supplements the standard capabilities of the Block IV system by providing a drive signal for the C-band transmitter while generating coherent translation frequencies for C-band (5-GHz) to S-band (2.2- to 2.3-GHz) Doppler extraction, C-band to L-band (1.6-GHz) zero delay measurements, and a level calibrated L-band test signal. Exciter functions are described, and a general explanation and description of the C-band uplink controller is presented.

  18. Relativistic Model for two-band Superconductivity

    OpenAIRE

    Ohsaku, Tadafumi

    2003-01-01

    To understand the superconductivity in MgB2, several two-band models of superconductivity were proposed. In this paper, by using the relativistic fermion model, we clearize the effect of the lower band in the superconductivity.

  19. 手助腹腔镜胃癌 D2根治术的团队配合%Teamwork Cooperation in Hand-assisted Laparoscopic D2 Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    周均; 曹永宽; 宋亚宁; 王永华; 张国虎; 王培红; 李旭

    2014-01-01

    目的:探讨手助腹腔镜胃癌D2根治术的团队配合技巧及重要性。方法对我中心2010年12月~2013年6月180例手助腹腔镜胃癌D2根治术的临床资料进行回顾性总结。术者及助手相对固定,只需术者及扶镜手两人相互配合,就能完成肿瘤的根治性切除及淋巴结清扫。结果180例均在手助腹腔镜下完成手术,全胃切除术84例,远端胃切除术81例,近端胃切除术15例。手术切口长度(6.9±0.5)cm;术中出血量(226.1±127.0)ml;手术时间(172.2±34.1)min;病检获淋巴结数(17.3±5.0)枚;术后住院时间(9.3±2.0) d。围手术期死亡1例,手术残端癌残留2例。手术相关并发症率6%(11/180)。术后随访1~24个月,失访12例(失访率7%),同时性肝转移4例,异时性淋巴结转移2例,局部复发1例,未发生切口和穿刺口种植。结论良好的团队配合是保证手助腹腔镜胃癌D2根治术的必备条件,对肿瘤的根治程度、手术时间及术后并发症的发生起着至关重要的作用。%Objective To discuss the importance of teamwork coorperation in hand-assisted laparoscopic D2 radical gastrectomy. Methods Clinical materials of 180 patients with gastric cancer undergoing hand-assisted laparoscopic D2 radical gastrectomy from December 2010 to June 2013 were summarized retrospectively.The lymph nodes dissection and radical tumor excision were performed by two persons of cooperation that the operator surgeon worked with camera assistant in a relatively fixed mode in the operation. Results The hand-assisted laparoscopic D2 radical gastrectomy was accomplished in all the patients.Among the 180 patients, gastrectomy was performed in 84 cases, distal gastrectomy in 81 cases, and proximal gastrectomy in 15 cases.The average length of incision was (6.9 ±0.5) cm, the blood loss was (226.1 ±127.0) ml, the operative time was (172.2 ±34.1) min, the number

  20. Metamaterial Absorbers in Terahertz Band

    Institute of Scientific and Technical Information of China (English)

    Qi-Ye Wen; Huai-Wu Zhang; Qing-Hui Yang; Man-Man Mo

    2013-01-01

    In recent years, a great deal of effort has been made to a create terahertz (THz) wave absorber based on metamaterials (MM). Metamaterials absorbers have a variety of potential applications including thermal emitters, detector, stealth technology, phase imaging, etc. In this paper, we firstly introduce the basic structure and work principle of the THz MM absorbers, and a transmission line model is developed for devices analysis. To expand the application of THz absorbers, dual-band and broadband THz MM absorbers are designed, fabricated, and measured. At the end of this article, the future development trends of MM absorbers are discussed.

  1. Bonds and bands in semiconductors

    CERN Document Server

    Phillips, Jim

    2009-01-01

    This classic work on the basic chemistry and solid state physics of semiconducting materials is now updated and improved with new chapters on crystalline and amorphous semiconductors. Written by two of the world's pioneering materials scientists in the development of semiconductors, this work offers in a single-volume an authoritative treatment for the learning and understanding of what makes perhaps the world's most important engineered materials actually work. Readers will find: --' The essential principles of chemical bonding, electron energy bands and their relationship to conductive and s

  2. Fatores prognósticos nas gastrectomias com linfadenectomia D2 por adenocarcinoma gástrico Prognostic factors in D2 gastrectomy for gastric adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Osvaldo Antonio Prado Castro

    2009-09-01

    comprometimento tumoral na câmara gástrica, o estádio da doença, a ocorrência de metástases a distância e principalmente a presença de metástases linfonodais, constituíram-se em variáveis com valor prognóstico independente.BACKGROUND: Lymphatic spread is more common in gastric cancer than the hematogenic one. Thus, the locoregional dissection type D2 seems to be important. AIM: To evaluate the overall survival after D2 gastrectomy for gastric adenocarcinoma and to determine the most important prognostic factors, including those with independent statistical value. METHODS: Prospective study with 125 patients operated between August 1997 and October 2005. The technique employed followed strictly the protocol of the National Cancer Center - Tokyo. RESULTS: There were 73 men and 52 women with ages ranging 28 to 84 years (mean of 58.96 ± 14.01. Seventy per cent of the lesions were located at the distal portion of the stomach, 20% were proximal and 10% comprised the whole organ. The stage distributions were: I - 37 cases (29.6%, II - 20 cases (16%, III - 37 cases (29.6%, and IV - 31 cases (24.8%. It was performed the amount of 73 subtotal gastrectomies and 52 totals. The morbidity rate was 26.4%, mainly, due to leakage and pulmonary complications. The overall mortality rate was 9.6%. After a mean follow-up of 48 months, 68 (54.4% patients were dead, representing an overall survival rate of 45.6%. Univariate and multivariate statistical analysis revealed that: tumors comprising the whole stomach, beyond the serosal layer (T3 or T4, with more than seven metastatic lymph nodes (N2 or N3, with distant metastasis (M1, and belonging to the stage III or IV of the disease, were related to a poor prognosis. CONCLUSIONS: Less than a half of the patients were alive after a mean follow-up of almost four years; the TNM stage system was the main prognostic factor, ergo, the extension of the lesions, the stage of the disease, metastatic occurrence and mainly the lymph node involvement

  3. 阴茎中部无针麻醉袖套式包皮环切治疗包皮过长%Mid-Penis Sleeve Circumcision with Needle-Free Jet Anaesthesia for the treatment of patients with redundant prepuce

    Institute of Scientific and Technical Information of China (English)

    张伟; 申岩; 杨文增; 穆银静; 崔振宇

    2011-01-01

    Objectives To investigate mid-penis sleeve circumcision with needle-free jet anaesthesia for the treatment of patients with redundant prepuce and observe the therapeutic effect.Methods Methods outpatient circumcision 80 cases with DPNB(dorsal of penis nerve blocked)anaesthesia were randomly divided into two groups,group A(40 cases)was underwent mid-penis sleeve circumcision with needle-free jet anaesthesia,group B(40cases)was done dorsal slit circumcision with traditional DPNB,to study the difference in Anaesthetic Volume,the time of take effect,visual analogue scale(VAS),bleeding voluroue,the condition of foreskin hydropsia,operative incision healing.appearance satisfication percentage.Results Group A has statistical difference to Group B in all ahove mentioned index.Conclusions Mid-penis sleeve circumcision with needle-free jet anaesthesia has many advantages over the dorsal slit circumcision with traditional DPNB,deserving generally clinical application.%目的 探讨阴攀中部无针麻醉袖套式包皮环切治疗包皮过长的效果.方法 选择包皮过长患者105例,随机分成A,B两组,A组40例,行阴茎中部无针麻醉袖套式包皮环切术,8组40例行传统阻滞麻醉及背侧切开环切术.对两组在麻醉剂量、起效时间、视觉模拟麻醉疼痛评分、出血量、水肿、切口愈合、外观满意度等方面进行比较.结果两组所有对比项目在两组之间的差异均有统计学意义.结论 阴茎中部无针麻醉袖套式包皮切除治疗包皮过长比传统阻滞麻醉及背侧切开环切术更具有优越性,值得临床推广.

  4. Pressure Bearing and Contact Analysis of Ball Injection Sliding Sleeve in Horizontal Well Staged Fracturing%水平井分段压裂投球滑套承压接触分析

    Institute of Scientific and Technical Information of China (English)

    徐玉龙; 程智远; 刘志斌; 李世恒; 韩永亮; 周后俊

    2012-01-01

    Due to the fact that there is no jection sliding sleeve for horizontal well staged mature matching tool for open hole completion in China, the ball infracturing suitable for Sulige Gasfield was developed. In light of the problem that the sleeve is not noticeably in place in fracturing operation, the finite element analysis software was adopted to establish the contact model of the sleeve and analyze the effect of different pressures on low-density ball, ball seat deformation and stress distribution. The analysis shows that when the operation pressure changes from 10 MPa to 20 MPa, the contact pressure is approximate to a linear change. When the pressure increases from 20 MPa to 50 MPa, the plastic deformation occurs between ball and ball seat, the contact area increases and the contact pressure increase slows down. When the pressure is 50 MPa, the maximum stress value of the ball seat reaches 358 MPa, exceeding the yield strength of low-density ball and ball seat to cause plastic deformation. But it does not reach the yield limit, satisfying the field operation requirement.%鉴于国内还没有成熟的裸眼完井配套工具,研制了适合苏里格气田的水平井分段压裂投球滑套,并针对投球滑套在压裂施工中到位不明显的问题,利用有限元分析软件ANSYS建立了投球滑套的接触模型,分析了不同压力对低密度球和球座变形与应力分布的影响。分析结果表明,施工压力由10 MPa增至20 MPa时,接触压力近似线性变化,当压力从20 MPa增加到50 MPa时,球和球座之间开始产生塑性变形,接触面积增加,从而使接触压力增加变慢。当压力为50 MPa时,球座最大应力值达到358 MPa,超过了低密度球和球座的屈服强度而发生了塑性变形,但是没有达到材料的屈服极限,满足压裂施工的要求。

  5. Mechanical Sleeve Switch for Multistage Water Layer Finding and Plugging%机械式滑套开关多级找堵水技术研究与应用

    Institute of Scientific and Technical Information of China (English)

    赵崇镇

    2016-01-01

    针对常规插管式多级找堵水管柱不能实现Ⅰ、Ⅲ层合采的问题,以及在封上采下时不能进行反洗和监测动液面影响了部分井生产资料录取的难题,研发了机械式滑套开关多级找堵水技术。该技术工艺管柱主要由Y441-114封隔器、滑套、开关工具、丢手接头及泄压球座等配套工具组成,通过下放或上提管柱使开关工具打开或关闭对应油层的滑套,实现多层之间分层开采或合采。现场12井次的应用结果表明,该工艺开关控制灵活,地面显示明显,调层成功率100%。机械式滑套开关多级找堵水技术为中浅油藏找堵水一体化工艺提供了新的技术支持。%Conventional stinger⁃type multistage water layer finding and plugging string can not realize joint production of Ⅰand Ⅲ layer, and can not conduct backwash and monitor the fluid level when isolating the upper section and producing the lower section, thus impacting the data recording of production wells�To address the is⁃sue , a mechanical sleeve switch for multistage water layer finding and plugging technology has been developed�The string mainly consists of Y441-114 packer, sleeve, switch tools, relief joint, pressure releasing ball seat and other supporting tools�Through lowering down and pulling up the string, the switch tool could open or close the sleeve corresponding to the reservoir, thus realizing separate layer production�Field application results of 12 wells show that the switch has good control flexibility, clear ground display and 100% success layer adjustment, thus of⁃fering a new technical support for integrated finding and plugging water layer in a shallow reservoir.

  6. Tap Teens' Curiosity with Lab Band.

    Science.gov (United States)

    Saunders, Jane

    2002-01-01

    Describes the Lab Band project used with 12th grade students at the Westgate Collegiate and Vocational Institute in Thunder Bay, Ontario (Canada). Explains that each band student taught a peer how to play their instrument which created versatility in the band. States that all students kept a reflective journal. (CMK)

  7. 全胃切除术后两种Roux-en-Y消化道重建方式疗效比较%Comparing two kinds of Roux-en-Y digestive tract reconstruction after the whole gastrectomy

    Institute of Scientific and Technical Information of China (English)

    郭志民; 郭鑫

    2015-01-01

    目的::探讨全胃切除术后单纯Roux-en-Y吻合和P式Roux-en-Y吻合两种消化道重建方式的临床效果。方法:回顾性分析2012年1月至2014年12月期间我院48例胃癌患者全胃切除术后分别行单纯Roux-en-Y吻合(24例)和P式Roux-en-Y吻合法(24例)两种消化道重建方式患者临床资料,比较患者术后Roux潴留综合症( RSS)、碱性返流性食管炎、营养状况指标的差异。结果: P式Roux-en-Y吻合组和单纯Roux-en-Y吻合组在患者碱性返流性食管炎发生率无统计学差异(P>0.05),但P式Roux-en-Y吻合组患者术后的Roux潴留综合征(RSS)发生率、术后3个月及12个月患者营养指标营养状况指标较单纯Roux-en-Y吻合组好(P0. 05),but the rates of P-type Roux-en-Y retention in post-operative patients with Roux-Y stasis syndrome after gastrectomy ( RSS) and the patients’ nutritional indicator after three months and even twelve months as well as nutrition indicators Roux Group were performed very well (P<0. 05). Conclusion:Compared to simple Roux-en-Y anastomosis after total gastrectomy,P-Roux-en-Y pouch gastric anastomosis has good effect and can improve patients’ quali-ty of life,so it is an ideal digestive tract procedure after total gastrectomy.

  8. 健康教育干预在胃癌根治术后患者的应用效果观察%Application of Health Education Intervention effect observation in patients with gastric cancer after radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    张志华

    2015-01-01

    Objective:To discuss the effect of health education intervention in patients after radical gastrectomy.Method:100 patients with gastric cancer were compared after radical gastrectomy in our hospital in groups,the effect of the mental state and physical state of them going through strong health education intervention in phychological and dietary aspects were observed and the following changes were recorded.Result:The patient’s mental state and physical condition in the experimental group were significantly better than those of the control group,differences between two groups were statistically significant(P<0.05).Conclusion:The application of psychological and dietary health education intervention to the patients after radical gastrectomy for gastric cancer results in a healthy and optimistic state of mind,improves the nutritional state after operation,thereby promoting the quality of life.%目的:探讨健康教育干预在胃癌根治术后患者的应用效果。方法:对笔者所在医院收治的100例胃癌根治术后患者进行分组比较,观察加强心理与饮食方面健康教育干预后胃癌根治术后患者心理状态与身体状态的变化效果。结果:观察组患者的心理状态、身体状态均显著优于对照组,两组比较差异均有统计学意义(P<0.05)。结论:加强心理与饮食方面的健康教育干预能使胃癌根治术后患者处于积极、健康、乐观的心理状态,改善术后身体营养状态,从而提高其生活质量。

  9. DUAL-BAND INFRARED DETECTORS

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    As the infrared technology continues to advance, there is a growing demand for multispectral detectors for advanced IR systems with better target discrimination and identification. Both HgCdTe detectors and quantum well GaAs/AlGaAs photodetectors offer wavelength flexibility from medium wavelength to very long wavelength and multicolor capability in these regions. The main challenges facing all multicolor devices are more complicated device structtures, thicker and multilayer material growth, and more difficult device fabrication, especially when the array size gets larger and pixel size gets smaller. In the paper recent progress in development of two-color HgCdTe photodiodes and quantum well infrared photodetectors is presented.More attention is devoted to HgCdTe detectors. The two-color detector arrays are based upon an n-P-N (the capital letters mean the materials with larger bandgap energy) HgCdTe triple layer heterojunction design. Vertically stacking the two p-n junctions permits incorporation of both detectros into a single pixel. Both sequential mode and simultaneous mode detectors are fabricated. The mode of detection is determined by the fabrication process of the multilayer materials.Also the performances of stacked multicolor QWIPs detectors are presented. For multicolor arrays, QWIP's narrow band spectrum is an advantage, resulting in low spectral crosstalk. The major challenge for QWIP is developing broadband or multicolor optical coupling structures that permit efficient absorption of all required spectral bands.

  10. 近端胃切除与全胃切除对SiewertⅡ~Ⅲ型食管胃结合部癌疗效比较的Meta分析%Proximal gastrectomy versus total gastrectomy for adenocarcinoma of esophagogastric junction:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    刘英俊; 韩广森; 王刚成; 万相斌; 任莹坤; 程勇; 蒋志强

    2014-01-01

    Objective To compare the efficacy of proximal gastrectomy (PG) and total gastrectomy (TG) for adenocarcinoma of esophagogastric junction. Methods Clinical trials comparing PG with TG for adenocarcinoma of esophagogastric junction published from 1990 to 2012 were searched in Cochrane library, Medline, Embase and China National Knowledge Infrastructure (CNKI), Wanfang Data. Review manager 5.0 was used for meta-analysis and outcome measures included mortality and complication morbidity, as well as nutritional state. Results A total of 10 studies including 2481 patients were identified and analyzed. The results showed no significant differences in the mortality (OR=1.00, P=0.99) and complication morbidity(OR=2.14, P=0.12) between PG and TG. However, anastomotic stenosis (OR=5.40, P<0.01) and reflux esophagitis (OR=7.12, P=0.01) were more frequently observed in PG group. The nutritional state in TG group was comparable with PG group (WMD=2.09, P=0.57). Conclusion TG is superior to PG in reducing the morbidity of anastomotic stenosis and reflux esophagitis.%目的:比较近端胃切除术和全胃切除术治疗食管胃结合部癌(SiewertⅡ~Ⅲ型)的疗效。方法检索Cochrane、Medline、Embase、中国期刊全文数据库及万方数据库中1990-2012年间比较近端胃切除术和全胃切除术治疗食管胃结合部癌的临床研究。使用RevMan 5.0软件对病死率、并发症发生率及术后营养状况进行Meta分析。结果共10篇文献2481例患者入选研究,其中近端胃切除组862例,全胃切除组1619例。分析显示,近端胃切除组与全胃切除组病死率(OR=1.00, P=0.99)、并发症发生率(OR=2.14, P=0.12)及术后营养状况(WMD=2.09, P=0.57)的差异均无统计学意义。全胃切除组较近端胃切除组术后吻合口狭窄(OR=5.40, P<0.01)及反流性食管炎(OR=7.12, P=0.01)的发生率明显降低。结论全胃切除术作

  11. Total gastrectomy with substitution of stomach by jejunal pouch with and without duodenal passage: study in rats Gastrectomy total com substituição do estômago por bolsa jejunal com e sem passagem do alimento pelo duodeno: estudo em ratos

    Directory of Open Access Journals (Sweden)

    Tertuliano Aires Neto

    2005-01-01

    Full Text Available PURPOSE: A comparison was done between the F. Paulino jejunal pouch (FP and a jejunal pouch (JP as esophagus-duodenum interpositional graft, for replacing the stomach after total gastrectomy. It was investigated the effect of the two procedures on esophagus histology, nutritional state and serum gastrin in rats. METHODS: Male Wistar rats weighing 282±17g were randomly submitted to sham operation (S, FP and JP after total gastrectomy. After eight weeks the rats were killed with overdose of anesthetic and tissue was taken from the distal esophagus for histology. Serum levels of total proteins, albumin, iron, transferring, folate, cobalamine, calcium, as well as serum gastrin were determined. Survival was considered. RESULTS: Fourty six rats were operated and thirty survived for eight weeks. Five (33.3% died after FP and 11 (52.3% after JP (p0.05. The JP rats had a significant decrease in serum albumin, glucose, transferrin, iron, folate and calcium, compared to sham (pOBJETIVO: Estudo comparativo foi realizado entre a bolsa jejunal de Fernando Paulino (FP e uma bolsa jejunal (JP interposta entre o esôfago e duodeno, para substituir o estômago após gastrectomia . Foi investigado o efeito dos dois procedimentos na histologia do esôfago, estado nutricional e gastrinemia sérica em ratos. MÉTODOS: Quarenta e seis ratos Wistar pesando 282±17g foram aleatoriamente submetidos a sham operation (S, FP e JP após gastectomia total. Decorridas 8 semanas, foi colhido sangue por punção cardíaca para dosagem de proteínas totais, albumina, ferro, transferrina, folato, cobalamina, calcio, e gastrina. Os animais receberam dose letal de anestésico e tecido do esôfago terminal foi retirado para histologia. Foi observada a mortalidade operatória dos animais. RESULTADOS: Quarenta e seis ratos foram operados e 30 sobreviveram por 8 semanas. Cinco (33,3 % morreram após FP e 11 (52,3% após JP (p0.05. Os ratos submetidos a JP tiveram uma diminui

  12. 商环包皮环切与传统袖套式包皮环切术后患者生活质量比较%Comparison of the quality of life after Shang-ring circumcision and Sleeve circumcision

    Institute of Scientific and Technical Information of China (English)

    王肖; 钱永; 杜永强

    2016-01-01

    Objective:To compare the effects between Shang-ring circumcision and Sleeve circumcision on the quality of life. Methods:One hundred and thirty adult patients with redundant prepuce and phimosis were treated with Shang-ring circumcision ( Shang-ring group,78 cases) and Sleeve circumcision( Sleeve group,52 cases) . The quality of life between two groups after operation were compared. Results:The pain in Shang-ring group was more than that in Sleeve group in postoperative 2 weeks(P0. 05). The physical composite scores after 1 to 2 weeks of operation and mental composite scores after 3 to 14 days of operation in Shang-ring group were significantly higher than those in Sleeve group(P 0.05)。商环组患者术后1~2周体能综合评分和术后3 d至2周思想综合评分均显著高于袖套组(P<0.01)。术后6周包皮环切手术后患者自慰相对困难,自慰快感减低,但对性生活质量无明显影响。结论:2种手术方式对患者术后生活质量影响各有侧重,包皮环切手术对性生活质量无明显的提高,对自慰有影响。

  13. Iliotibial band syndrome: evaluation and management.

    Science.gov (United States)

    Strauss, Eric J; Kim, Suezie; Calcei, Jacob G; Park, Daniel

    2011-12-01

    Iliotibial band syndrome is a common overuse injury typically seen in runners, cyclists, and military recruits. Affected patients report lateral knee pain associated with repetitive motion activities. The diagnosis is usually made based on a characteristic history and physical examination, with imaging studies reserved for cases of recalcitrant disease to rule out other pathologic entities. Several etiologies have been proposed for iliotibial band syndrome, including friction of the iliotibial band against the lateral femoral epicondyle, compression of the fat and connective tissue deep to the iliotibial band, and chronic inflammation of the iliotibial band bursa. The mainstay of treatment is nonsurgical; however, in persistent or chronic cases, surgical management is indicated.

  14. Evolutions of Compaction Bands of Saturated Soils

    Institute of Scientific and Technical Information of China (English)

    鲁晓兵; 王义华; 崔鹏

    2004-01-01

    The development of compaction bands in saturated soils, which is coupling-rate, inertial and pore-pressure-dependent, under axisymmetric loading was discussed, using a simple model and a matching technique at the moving boundary of a band. It is shown that the development of compaction bands is dominated by the coupling-rate and pore-pressure effects of material. The soil strength makes the band shrinking, whilst pore pressure diffusion makes the band expand. Numerical simulations were carried out in this paper.

  15. a Bariatric Surgery Department

    Directory of Open Access Journals (Sweden)

    Ramon Vilallonga

    2012-01-01

    Full Text Available Objective. Robot-assisted sleeve gastrectomy has the potential to treat patients with obesity and its comorbidities. To evaluate the learning curve for this procedure before undergoing Roux en-Y gastric bypass is the objective of this paper. Materials and Methods. Robot-assisted sleeve gastrectomy was attempted in 32 consecutive patients. A survey was performed in order to identify performance variables during completion of the learning curve. Total operative time (OT, docking time (DT, complications, and length of hospital stay were compared among patients divided into two cohorts according to the surgical experience. Scattergrams and continuous curves were plotted to develop a robotic sleeve gastrectomy learning curve. Results. Overall OT time decreased from 89.8 minutes in cohort 1 to 70.1 minutes in cohort 2, with less than 5% change in OT after case 19. Time from incision to docking decreased from 9.5 minutes in cohort 1 to 7.6 minutes in cohort 2. The time required to dock the robotic system also decreased. The complication rate was the same in the two cohorts. Conclusion. Our survey indicates that technique and outcomes for robot-assisted sleeve gastrectomy gradually improve with experience. We found that the learning curve for performing a sleeve gastrectomy using the da Vinci system is completed after about 20 cases.

  16. Inter-Band Radiometric Comparison and Calibration of ASTER Visible and Near-Infrared Bands

    Directory of Open Access Journals (Sweden)

    Kenta Obata

    2015-11-01

    Full Text Available The present study evaluates inter-band radiometric consistency across the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER visible and near-infrared (VNIR bands and develops an inter-band calibration algorithm to improve radiometric consistency. Inter-band radiometric comparison of current ASTER data shows a root mean square error (RMSE of 3.8%–5.7% among radiance outputs of spectral bands due primarily to differences between calibration strategies of the NIR band for nadir-looking (Band 3N and the other two bands (green and red bands, corresponding to Bands 1 and 2. An algorithm for radiometric calibration of Bands 2 and 3N with reference to Band 1 is developed based on the band translation technique and is used to obtain new radiometric calibration coefficients (RCCs for sensor sensitivity degradation. The systematic errors between radiance outputs are decreased by applying the derived RCCs, which result in reducing the RMSE from 3.8%–5.7% to 2.2%–2.9%. The remaining errors are approximately equal to or smaller than the intrinsic uncertainties of inter-band calibration derived by sensitivity analysis. Improvement of the radiometric consistency would increase the accuracy of band algebra (e.g., vegetation indices and its application. The algorithm can be used to evaluate inter-band radiometric consistency, as well as for the calibration of other sensors.

  17. The expanded perlite insulation of the riser sleeve in cement machinery in steel cast production%珍珠岩保温冒口套在铸钢件生产上的应用

    Institute of Scientific and Technical Information of China (English)

    何素立

    2012-01-01

    The compositions of expanded perlite insulation of riser sleeves include perlite, water glass and clay composites. This paper analyzes the heat preservation during production. The initial test shows that the thermal insulation of casting quality is normal and it saves 30%50% of steel, with the yield in- creased by 14%.%膨胀珍珠岩复合型保温冒口套的保温材料由膨胀珍珠岩、水玻璃及陶土组成.分析了其保温机理及制作工艺.初步生产试验表明,使用这种保温材料铸件质量正常,单个冒口节约钢水30%~50%,工艺出品率平均提高14%左右.

  18. A Novel Ku-Band/Ka-Band and Ka-Band/E-Band Multimode Waveguide Couplers for Power Measurement of Traveling-Wave Tube Amplifier Harmonic Frequencies

    Science.gov (United States)

    Wintucky, Edwin G.; Simons, Rainee N.

    2015-01-01

    This paper presents the design, fabrication and test results for a novel waveguide multimode directional coupler (MDC). The coupler, fabricated from two dissimilar frequency band waveguides, is capable of isolating power at the second harmonic frequency from the fundamental power at the output port of a traveling-wave tube (TWT) amplifier. Test results from proof-of-concept demonstrations are presented for a Ku-band/Ka-band MDC and a Ka-band/E-band MDC. In addition to power measurements at harmonic frequencies, a potential application of the MDC is in the design of a satellite borne beacon source for atmospheric propagation studies at millimeter-wave (mm-wave) frequencies (Ka-band and E-band).

  19. Reconstruction of esophagojejunostomy by robot-sewing technique in totally robotic total gastrectomy%应用手术机器人系统行食管空肠吻合可行性观察

    Institute of Scientific and Technical Information of China (English)

    江志伟; 赵坤; 王刚; 刘凤涛; 周俊杰; 张小磊; 李宁; 黎介寿

    2012-01-01

    Objective To analyze the feasibility of reconstruction of esophagojejunostomy by robot-sewing technique in totally robotic total gastrectomy for gastric cancer. Methods The clinical data of 20 cases of gastric cancer performed da Vinci robotic total gastrectomy including robot-sewn esophagojejunal Roux-en-Y anastomosis between May 2011 and November 2011 at Nanjing General Hospital of Nanjing Military Command were analyzed retrospectively. Results All robotic surgeries were accomplished in 20 cases successfully. Among them, 13 cases were men and 7 were women; the mean age (±SD) was (57.8±6.5) years. The mean (±SD) operation time was (245.5±53.0) mins with a mean (±SD) blood loss of (75.5 ± 50.3) mL. There was neither intraoperative complication nor postoperative complication such as stoma leakage, bleeding, abdominal cavity infection and so on in all cases. Only one case was readmitted for complication of afferent loop intestinal obstruction and received reoperation. The mean (±SD) postoperative hospital stay was (6.4±2.5) days. Conclusion A robot-sewn anastomosis for esophagojejunostomy reconstruction in robotic total gastrectomy for gastric cancer is simple, safe and feasible. It may be a standard surgical technique for totally robotic total gastrectomy for gastric cancer.%目的 分析应用手术机器人系统进行胃癌全胃切除与食管空肠Roux-en-Y吻合术的安全性及有效性.方法 回顾性分析2011年5~11月南京军区南京总医院对20例胃癌病人应用达芬奇手术机器人系统进行胃癌全胃根治切除与食管空肠Roux-en-Y吻合术的临床资料.结果 20例胃癌病人施行了全机器人全胃切除及食管空肠吻合术,其中男13例,女7例;年龄平均(57.8±6.5)岁.手术时间平均(245.5±53.0)min,出血量平均(75.5±50.3) mL.无术中并发症发生,术后无吻合口漏、出血、腹腔感染等并发症,仅1例病人术后发生输入袢肠梗阻,经再手术治疗后

  20. Clinical Effect of Keeping Vagus Nerve Radical Gastrectomy for Gastric Cancer Patients%保留迷走神经胃癌根治术治疗胃癌患者的临床疗效

    Institute of Scientific and Technical Information of China (English)

    谭贵永

    2013-01-01

    Objective:To analyze the clinical effect of keeping vagus nerve radical gastrectomy in treatent of gastric cancer patients.Method:114 cases of gastric cancer patients were randomly divided into research group(64 cases)and control group(50 cases). Patients in research group were treated with keeping vagus nerve radical gastrectomy and patients in control group were treated with traditional radical gastrectomy. The operative bleeding volume,operative time,postoperative anal exhaust and defecate time,intraoperative lymph node scanning ratio,occurrence rate of complication and 5 years survival rate were analyzed and compared. Result:There were no significant differences between two groups about operative bleeding volume and time(P>0.05). The postoperative anal exhaust and defecate time of research group was shorter than that in control group. The intraoperative lymph node scanning ratio was high,occurrence rate of complication was low and 5 years survival rate was high in research group. Eating situation total effect of research group was significantly better than that in control group(P<0.05). Conclusion:The clinical effect is better of keeping vagus nerve radical gastrectomy in treatment of gastric cancer patients and it is worthy of popularization and application.%  目的:分析保留迷走神经胃癌根治术治疗胃癌患者的临床疗效。方法:将114例胃癌患者分为观察组(64例)与对照组(50例),分别采用保留迷走神经胃癌根治术和传统胃癌根治术治疗,对手术出血量、手术时间、术后肛门排气和排便时间,以及术中淋巴结扫描比、手术并发症发生率和5年生存率分别统计比较。结果:在手术出血量和手术时间上,两组差异无统计学意义;术后排气和排便时间观察组相对更短;另外,观察组手术淋巴结扫描比更高,术后并发症发生率更低,5年生存率明显更高;术后12个月观察组患者进食情况明显更佳

  1. Clinical analysis of subtotal gastrectomy in treatment of 40 cases of acute peptic ulcer perforation%胃大部切除术治疗消化性溃疡急性穿孔40例临床分析

    Institute of Scientific and Technical Information of China (English)

    金德华

    2013-01-01

    Objective To investigate the clinical efficacy and safety of subtotal gastrectomy in the treatment of acute gastric ulcer perforation. Methods Eighty patients with acute gastric ulcer perforation admitted to our hospital from February 2009 to April 2011 were analyzed retrospectively.The observation group, consisting of 40 patients,received subtotal gastrectomy;The control group,consisting of 40 patients, received simple neoplasty.The postoperative ulcer recurrence rate,complications,hospital stay,operative time and other indicators of the two groups were compared. Results The observation group had 4 patients with grade Ⅲ Visick and 3 patients with grade Ⅳ Visick,and the control group had 6 patients with grade Ⅲ Visick and 7 patients with grade Ⅳ Visick,with statistically significant difference between the two groups (P0.05).The observation group and the control group had statistically significant differences in the operative time and hospital stay [(2.3±0.5) and (1.2±0.3) hours,(7.3±2.4) and (5.1±1.7) days,t=34.617,30.019,P=0.032,0.041]. Conclusion Subtotal gastrectomy has better long-term efficacy than simple gastric perforation repair.Under permitting conditions and with informed consent of patients, subtotal gastrectomy should be adopted as far as possible for patients with acute gastric perforation.%目的探讨胃大部分切除术急性胃溃疡穿孔的临床疗效及安全性。方法回顾性分析我院2009年2月~2011年4月收治的急性胃溃疡胃穿孔患者40例作为观察组,采用选胃大部切除术;选取同期行单纯修补术治疗急性胃溃疡胃穿孔患者40例作为对照组,比较两组术后溃疡复发率、并发症、住院天数及手术时间等各指标情况。结果观察组患者VisickⅢ级4例,VisickⅣ3例,对照组患者VisickⅢ级6例,VisickⅣ7例,二者差异有统计学意义(P<0.05);两组患者术后并发症发生率(5%和7.5%)比较,差异无统计学意义(P>0.05

  2. Giemsa C-banding of Barley Chromosomes. I: Banding Pattern Polymorphism

    DEFF Research Database (Denmark)

    Linde-Laursen, Ib

    1978-01-01

    Twenty barley (Hordeum vulgare) lines studied had a common basic chromosome banding pattern. Most bands ranged from medium to very small in size. The most conspicuous banding occurred at or near the centromeres, in the proximal, intercalary parts of most chromosome arms and beside the secondary c...... 7. Seventeen differently banded karyotypes were found. Some banding pattern polymorphisms can be used in cytological and cytogenetic studies....

  3. Effective band structure of random alloys.

    Science.gov (United States)

    Popescu, Voicu; Zunger, Alex

    2010-06-11

    Random substitutional A(x)B(1-x) alloys lack formal translational symmetry and thus cannot be described by the language of band-structure dispersion E(k(→)). Yet, many alloy experiments are interpreted phenomenologically precisely by constructs derived from wave vector k(→), e.g., effective masses or van Hove singularities. Here we use large supercells with randomly distributed A and B atoms, whereby many different local environments are allowed to coexist, and transform the eigenstates into an effective band structure (EBS) in the primitive cell using a spectral decomposition. The resulting EBS reveals the extent to which band characteristics are preserved or lost at different compositions, band indices, and k(→) points, showing in (In,Ga)N the rapid disintegration of the valence band Bloch character and in Ga(N,P) the appearance of a pinned impurity band.

  4. Fade Mitigation Techniques at Ka-Band

    Science.gov (United States)

    Dissanayake, Asoka (Editor)

    1996-01-01

    Rain fading is the dominant propagation impairment affecting Ka-band satellite links and rain fade mitigation is a key element in the design of Ka-band satellite networks. Some of the common fade mitigation techniques include: power control, diversity, adaptive coding, and resource sharing. The Advanced Communications Technology Satellite (ACTS) provides an excellent opportunity to develop and test Ka-band rain impairment amelioration techniques. Up-link power control and diversity are discussed in this paper.

  5. Multi-band Modelling of Appearance

    DEFF Research Database (Denmark)

    2002-01-01

    the appearance of both derived feature bands and an intensity band. As a special case of feature-band augmented appearance modelling we propose a dedicated representation with applications to face segmentation. The representation addresses a major problem within face recognition by lowering the sensitivity...... to lighting conditions. Results show that localisation accuracy of facial features is considerably increased using this appearance representation under normal and abnormal lighting and at multiple scales....

  6. Multi-band Modelling of Appearance

    DEFF Research Database (Denmark)

    Stegmann, Mikkel Bille; Larsen, Rasmus

    2003-01-01

    the appearance of both derived feature bands and an intensity band. As a special case of feature-band augmented appearance modelling we propose a dedicated representation with applications to face segmentation. The representation addresses a major problem within face recognition by lowering the sensitivity...... to lighting conditions. Results show that the localisation accuracy of facial features is considerably increased using this appearance representation under diffuse and directional lighting and at multiple scales....

  7. Coherent band pathways between knots and links

    CERN Document Server

    Buck, Dorothy

    2014-01-01

    We categorise coherent band (aka nullification) pathways between knots and 2-component links. Additionally, we characterise the minimal coherent band pathways (with intermediates) between any two knots or 2-component links with small crossing number. We demonstrate these band surgeries for knots and links with small crossing number. We apply these results to place lower bounds on the minimum number of recombinant events separating DNA configurations, restrict the recombination pathways and determine chirality and/or orientation of the resulting recombinant DNA molecules.

  8. Band engineering of thermoelectric materials.

    Science.gov (United States)

    Pei, Yanzhong; Wang, Heng; Snyder, G J

    2012-12-01

    Lead chalcogenides have long been used for space-based and thermoelectric remote power generation applications, but recent discoveries have revealed a much greater potential for these materials. This renaissance of interest combined with the need for increased energy efficiency has led to active consideration of thermoelectrics for practical waste heat recovery systems-such as the conversion of car exhaust heat into electricity. The simple high symmetry NaCl-type cubic structure, leads to several properties desirable for thermoelectricity, such as high valley degeneracy for high electrical conductivity and phonon anharmonicity for low thermal conductivity. The rich capabilities for both band structure and microstructure engineering enable a variety of approaches for achieving high thermoelectric performance in lead chalcogenides. This Review focuses on manipulation of the electronic and atomic structural features which makes up the thermoelectric quality factor. While these strategies are well demonstrated in lead chalcogenides, the principles used are equally applicable to most good thermoelectric materials that could enable improvement of thermoelectric devices from niche applications into the mainstream of energy technologies.

  9. Density of States for Warped Energy Bands

    Science.gov (United States)

    Mecholsky, Nicholas A.; Resca, Lorenzo; Pegg, Ian L.; Fornari, Marco

    2016-02-01

    Warping of energy bands can affect the density of states (DOS) in ways that can be large or subtle. Despite their potential for significant practical impacts on materials properties, these effects have not been rigorously demonstrated previously. Here we rectify this using an angular effective mass formalism that we have developed. To clarify the often confusing terminology in this field, “band warping” is precisely defined as pertaining to any multivariate energy function E(k) that does not admit a second-order differential at an isolated critical point in k-space, which we clearly distinguish from band non-parabolicity. We further describe band “corrugation” as a qualitative form of band warping that increasingly deviates from being twice differentiable at an isolated critical point. These features affect the density-of-states and other parameters ascribed to band warping in various ways. We demonstrate these effects, providing explicit calculations of DOS and their effective masses for warped energy dispersions originally derived by Kittel and others. Other physical and mathematical examples are provided to demonstrate fundamental distinctions that must be drawn between DOS contributions that originate from band warping and contributions that derive from band non-parabolicity. For some non-degenerate bands in thermoelectric materials, this may have profound consequences of practical interest.

  10. Triaxial superdeformed bands in {sup 86}Zr

    Energy Technology Data Exchange (ETDEWEB)

    Sarantites, D.G.; LaFosse, D.R.; Devlin, M.; Lerma, F. [Chemistry Department, Washington University, St. Louis, Missouri 63130 (United States); Wood, V.Q.; Saladin, J.X.; Winchell, D.F. [Physics Department, University of Pittsburgh, Pittsburgh, Pennsylvania 15260 (United States); Baktash, C.; Yu, C. [Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831 (United States); Fallon, P.; Lee, I.Y.; Macchiavelli, A.O.; MacLeod, R.W. [Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States); Afanasjev, A.V.; Ragnarsson, I. [Department of Mathematical Physics, Lund Institute of Technology, Box 118, S-22100 Lund (Sweden)

    1998-01-01

    Four new superdeformed bands have been found in the nucleus {sup 86}Zr. The good agreement between experiment and configuration-dependent shell correction calculations suggests that three of the bands have triaxial superdeformed shapes. Such unique features in mass A{approximately}80 superdeformed bands have been predicted, but not observed experimentally until now. A fourth band in {sup 86}Zr is interesting due to a fairly constant and unusually high dynamic moment of inertia. Possible interpretations of this structure are discussed. {copyright} {ital 1998} {ital The American Physical Society}

  11. Magnetic resonance imaging of iliotibial band syndrome.

    Science.gov (United States)